Article Type : Review Article
Authors : Tomasello L
Keywords : Dyslexia; Inclusion; Work
Specific Learning Disorders (SLDs) denote
a category of neurodevelopmental disorders. This paper, therefore, in addition
to analyzing Specific Learning Disorders, also aims to offer practical insights
and operational strategies to promote the inclusion and well-being of persons
with SLDs in work system, as well as in society. From DSAs there is no cure, it
is important that this issue be given as much attention as possible to protect
and guarantee workers' rights as well with dyslexia through a process of
inclusion. Therefore, this paper aims to examine and create as comprehensive an
understanding as possible toward the experience of adults with dyslexia within
the work environment and to emphasize that a diagnosis of DSA is not negative
but only represents a characteristic of the person.
Dyslexia is a Specific Learning Disorder (SLD) that
affects a person's ability to read. The etymology of the word comes from Greek
and is composed of "dys" meaning missing or inadequate and
"lexis" meaning word or speech. In common sense, dyslexia is still
associated with poor intellectual abilities (IQ) or even cognitive delays. These misconceptions have no basis in
scientific research, research, documents, how there is no connection. Dyslexia
falls under the category of learning disabilities (LD). The causes of dyslexia
are still uncertain but the scientific literature supports that it is due to a
neurobiological cause with inherited characteristics. Sixty-five percent of
children with dyslexia have a family member with the same disorder [1]. Studies
in neurobiology, point to the origin of dyslexia in one of the associative
areas of the brain, the parieto-temporo-occipital area [2]. This area is
connected to the somatic cortical areas that send visual-auditory sensory
information to the former; when this is received, the parieto-temporo-occipital
area processes the sensory information and interprets it to understand
language. Other studies attribute the point of origin to the striate or primary
visual cortex used to recognize and encode visual stimuli [3].
Phonological Deficit Theory, attributes the 'main
impediment to a gap in the language system, phonological awareness or phonological
awareness. People with dyslexia show difficulty in recognizing that words can
be reduced into phonemes, the smallest phonetic units of language. The phoneme,
is the minimal sound unit of language. It is at this level that the deficit
that characterizes dyslexia is identified. Reading requires operations that
consist of: seeing the word, breaking it down into its basic phonemes, being
able to recognize them and finally assembling them. People with dyslexia show
difficulty in the process of breaking down and reassembling phonemes, thus
making reading and consequently understanding individual words difficult. In
addition to the phonological factor, some studies support the link between
working memory deficits and reading difficulties; a deficiency in verbal
short-term memory has been identified in people with ASD [4]. Verbal memory is
a component of working memory, responsible for metaphonological ability, that
is, the ability to correlate a sign with a sound and memorize the association.
Due to the deficit, this ability is lost and information retrieval becomes so
difficult that it "overloads" short-term memory. Therefore, people
with ASD show statistically lower scores in phonological short-term memory,
reading, fluency and text decoding [5]. Dyslexia, dysgraphia, dysorthographia,
and dyscalculia as specific learning disorders, hereinafter referred to as
"SLDs," which manifest themselves in the presence of adequate
cognitive abilities, in the absence of neurological pathologies and sensory deficits,
but may constitute a major limitation for some activities of daily
living". Taking the acronym into analysis based on the single letter
"D" refers to the term "Disorder" related to the clinical
dimension that, signal how far they deviate from the norm in the areas of
reading, writing and computation. It is necessary to distinguish learning
disabilities, from Specific Learning Disorders.
The Disorder is innate, it is not caused by the
presence of environmental, social or emotional factors that may interfere with
the proper acquisition of skills and abilities; learning difficulties, are
consequent to general situations and conditions of discomfort and for that
reason are considered transitory, since once the disadvantageous situation is
rebalanced, they can resolve, therefore Specific Learning Disorders are a
condition that will be present throughout his life. "S" is the second
letter in the acronym and refers to "Specific."
"Specificity" is really about a specific domain of impaired abilities
that nevertheless leave overall intellectual functioning. A distinction must be
made between specific and nonspecific disorders. The former occur when there
are specific skills impaired: deficits in reading (dyslexia), deficits in
writing (dysgraphia/ dysorthography), and deficits in mathematical calculation
(dyscalculia). The latter, on the other hand, concerning when the child has
developmental deficits in all areas of learning and has difficulty in acquiring
various knowledge (e.g., cognitive disabilities, autism, ADHD, etc.). The
acronym "A" refers to "Learning" i.e., the acquisition of
basic school skills that relate precisely to the first exposure the formal
teaching of written, spoken language and computation. ASDs are not a disease,
they do not relate to an organic impairment, but are due a different neuro
functioning of the brain is a constitutional condition with a genetic
component. In ASDs, it is called neuro diversity, and it causes problems of
slowness during information processing in different aspects: reading, writing,
mental calculation, working memory (a very important feature in school learning
activities, which will accompany individuals throughout their lives; from
specific learning disorders one does not "recover," but these
difficulties can be compensated with time and the right tools.
Specific Learning Disorders (SLDs) denote a category
of neurodevelopmental disorders. It is initially crucial to distinguish the
term learning difficulty from the term specific learning disorder. The former
refers to any school difficulty that can be modified with targeted
interventions, the latter term implies the presence of a more severe and innate
deficit, and is the result of a diagnostic process. By Specific we define
processes concerning the need to learn generally automatic activities. By
Learning we indicate those processes that increase a given ability due to
experience and external social context. In Italy, with the publication of Law
170/2010 [6], a Consensus Conference was held in Rome on December 6 and 7,
2010, which showed that specific learning disorders affect about 3 percent of
Italian pupils. These disorders are neurobiological in origin; they interfere
with the normal process of acquiring reading, writing and/or calculation.
Environmental and social factors, such as school and family context, are
intertwined with neurobiological ones and contribute to determining the
disorder and the degree of maladjustment. The international diagnostic manuals that
define ASD are the ICD- 111 in which ASDs are classified within
neurodevelopmental disorders. The DSM 5 [7] in which ASDs are framed
dimensionally as disorders of reading, written expression and computation.
The disorders, involve a specific skill domain, global intellectual functioning remains intact, they are called "specific" in that, based on the skill involved they take on a specific connotation thus classified by their respective codes in the ICD - 10 diagnostic manual:
In the DSM - V diagnostic manual the disorder codes as follows:
Following the publication of the DSM - V (APA, 2014).
Three levels of severity of ASDs were introduced:
The diagnostic guidelines in the area of ASDs provide
five basic criteria to be met: First criterion: there must be a clinically
significant degree of impairment of the specific skill, second criterion: the
impairment must be specific, in the sense that it must not be attributable only
to a mental retardation, third criterion: the impairment must be developmental,
it must be present in the early years of schooling and not acquired later as a
result of, for example, cerebral palsy, fourth criterion: there must be no
external factors capable of explaining the schooling difficulties, such as a
family trauma, fifth criterion: the impairment must not be directly due to
uncorrected defects in vision or hearing. At the Italian level, the Consensus
Conference in January 2007 in its Recommendations indicated as a crucial
element for the identification of DSAs the criterion of the
"discrepancy" between ability of the specific domain concerned
(deficient in relation to expectations by age and/or class attended) and
general intelligence (appropriate to chronological age) [8]. From a standpoint
of causes and period of onset, dyslexia can be divided into: acquired or
developmental [7]. Acquired dyslexia refers to those reading disorders that
arise as a consequence of brain damage, in individuals in whom reading skills
were originally in the normal range. In contrast, developmental dyslexia is a
specific disorder that inhibits the normal process of reading acquisition that
may be associated with a simple slowing of the developmental process.
The procedures needed to define specific reading decoding disorder reported by the Consensus Conference are:
The minimum age at which a diagnosis of specific
reading disorder can be made coincides with the completion of the second grade
of elementary school.
In DSM V5 [7] the guidance for making diagnoses of dyslexia indicates that these criteria must be met:
In summary, normal variations in reading skills should
be differentiated from dyslexia, which can be diagnosed only if the individual
has been provided with adequate educational and cultural opportunities, if his
or her IQ is average, and if he or she has no sensory deficits that can alone
explain reading problems. In the dyslexic student, difficulties are not only
related to working memory (retaining and retrieving information), but also to
limitations related to lexical access, that is, the inability to remember the
name of an object or a place. If short-term memory is impaired, information is
lost even before it is processed.
Dysorthography and Dysgraphia Specific writing
disorder is divided into Dysorthography and Dysgraphia, depending on whether it
affects spelling or handwriting.
Dysorthography is the difficulty in translating
corresponding sounds into graphic signs, while possessing adequate language in
terms of lexical pronunciation and expressive skills. Thus, the same errors are
manifested at the spelling level that dyslexia presents in reading.
Dysorthographia concerns the use, when writing, of the
correct application of grammatical rules [7].
The term dysgraphia, that is, the difficulty in making
graphic gestures, refers to a disturbance in the process of transforming
phonemes into graphemes; the dysgraphic person has messy, unclear handwriting
accompanied by a difficulty in mastering drawing tools. Therefore, using spaces
correctly or orienting the writing of the paper may represent a discomfort.
Individuals with specific writing disorder, fearful of
being judged for the errors they might make, avoid using complex terms or
elaborate sentences, making their writing meager and poor in vocabulary.
For diagnostic assessment, it is necessary to
administer standardized tests; specifically, for dysorthographia, the
assessment parameter of correctness, consisting of the number of errors and
their percentile distribution, below the fifth percentile is shared, while for
dysgraphia, it seems to be a consequence of motor execution disorders of the
dyspraxic order.
According to ICD -10 and DSM V to make a diagnosis of Written Expression Disorder, these criteria must be met:
The DSM - V in accordance with the ICD - 10 identifies
calculus disorder as characterized primarily by underperformance based on the
subject's chronological age in calculus skills, as measured by standardized
tests administered individually in subjects with cognitive abilities of
learning in the normal range. This is therefore referred to as basic ability to
learn calculus. Dyscalculia is among the least studied and recognized DSAs
because it has a lower incidence than the other specific learning disorders.
For diagnostic evaluation, as with the other disorders described above,
standardized tests are needed that provide parameters to assess correctness and
speed. According to the two diagnostic reference manuals, the diagnostic
criteria for numeracy disorder are: correctness and especially the parameter of
rapidity, in that the clinician must be shown to be slow enough to support the
hypothesis that the process is not automated. In addition, memorization of
arithmetic facts and correct mathematical reasoning are also referred to,
although there is general agreement in excluding difficulties with mathematical
problem solving from the diagnosis of a computation disorder, it is recommended
that the components involved in problem solving be investigated further.
Taking these aspects into consideration, it is useful
to define the degree of the pupil's academic functioning, as no child with
dyscalculia is identical to another. One has to analyze each child on an
individual and specific level in order to design a tailored rehabilitation
intervention.
Parents and teachers can do much to facilitate the
development of numerical competence in the child: from games to compare
quantities, add, take away, divide (in kindergarten).
During the elementary school years, one can help the
child with mathematics by dealing with tangible materials, dividing sheets,
using a number line, the support of calculations through hands. It is very
important that parents and teachers follow a single teaching guideline.
Specific learning disorders, as analyzed so far, have
a genetic basis for this reason difficult to modify and sometimes to improve.
It is important to make the child with ASD understand that he should not blame
himself, he should strive like his peers, with the help of available tools,
teachers, and clinicians, he should strive and figure out which study method is
most congenial to him.
Studies on dyslexia, mostly concern, children and
adolescents often still students. Only recently have studies looked at adults.
In the 2014 study by Nergard-Nilssen, T. and Hulme, C., [9] the researchers
subjected a group of adults with suspected ASD and a control group to a series
of verbal tests and then compared the results. The dyslexic group reported a
marked decrease in scores on spelling, word identification, phonological
decoding, and scores that were at least moderately lower in all reading-related
texts. There was no difference between the two groups' scores in text
comprehension and cognitive skills, the result confirming the hypothesis that
dyslexia does not affect IQ. However, the main factor that differentiates the
two groups the most is not reading, but spelling, followed by reading
efficiency and accuracy. These symptoms are therefore significant in how much
dyslexia can affect the quality of adult life. Moreover, most adults with ASD
cannot recognize these symptoms in themselves. Dyslexia causes great emotional
impact not only in school-age children and young people, but also in adults
especially in the work environment. The importance of diagnosing dyslexia at
school age, carried out no earlier than the end of the second grade, is
recognized. This stems from the need to allow the child to develop according to
his specific needs as soon as possible and avoid blaming him for his
shortcomings. There is still not much awareness of dyslexia among adults;
getting a diagnosis is necessary to ensure that people with ASD have greater
satisfaction in both private and working life. The influence of the disorder is
not only limited to the work environment but can also involve recreational
activities and personal relationships [10]. Dyslexia is a specific learning
disorder that affects almost 3 million citizens in Italy, many of whom, enter
the working world. The issue, is particularly focused on in order to protect
and guarantee the rights of workers, to ensure a process of inclusion for all.
In Italy, the quality of working life for people with
DSA in Italy is alarming. The survey on access to the world of work for people
with DSA carried out by the Italian Association for Dyslexia (AID) in 2021,
reports that 70% of people with dyslexia surveyed have difficulties in their
work attributable to DSA, 70% of participants reported receiving reprimands for
errors attributable to DSA, 37% have experienced detriment in their pay,
career, or job duties, and 12% report having been fired for their dyslexia
awareness of dyslexia is needed to promote job inclusion. Law 25 of March 28,
guarantees all workers with dyslexia access to compensatory tools both during
work hours and during all types of tests with assessment. This represents a
process toward the inclusion of people with learning disabilities, but the law
is still far from perfect. In fact, it is important to note that all these
rights are guaranteed only for people who have an official diagnosis. In Italy,
As Martino states, "The diagnosis of dyslexia in adults still appears to
be somewhat limited in Italy, as diagnostic services in the developmental field
cannot take on subjects who are over 18 years old, while services that make
neuropsychological diagnoses in adults rarely deal with dyslexia" [11]. It
is therefore possible to clearly understand that the problem of diagnosis also
lies in the difficulty of being able to find a diagnostic service for people
over 18.
The challenges that people with dyslexia face in their
adult lives are numerous, but the context where they are concentrated is the
workplace. These difficulties may be due to the symptoms of dyslexia or a
non-inclusive work environment. It is a common attitude not to tell anyone
about one's condition because of fears of negative repercussions; in the common
sense, dyslexia is still very much linked to prejudice and stereotypes, and
people are often judged negatively for their condition. Morris and Turnbull
[12], report that not wanting to disclose one's condition at work stem from
fears of being ridiculed, victimized, and concerns about not being understood.
Dyslexia is one of the hidden disabilities, that is, a disability that is not
seen, this leads many people to believe that the impact of the condition is not
that important or even believe that it does not exist. If the worker, does not
declare his or her dyslexia, he or she will not be able to seek the appropriate
compensatory tools. However, not seeking the appropriate tools may in the long
run lead to negative consequences in the person's mental health. In the
meta-analysis conducted by De Beer [13] it is reported that not using the
necessary compensatory tools can cause a negative impact on stress levels. It
is reported that "unsupported dyslexic people have higher levels of stress
and anxiety." If this state is prolonged over time, it is possible to
incur chronic stress situations that then go on to afflict the individual for a
long time. The challenges each person with dyslexia faces at work are related
to the type of work he or she does, the role he or she plays, or the work
context. However, there are also common difficulties that relate to the work
environment: "time management," organization, planning, structuring
written communications, and presenting information [14]. Complex tasks that
cause too much workload, places that are too noisy or have too many
distractions where work can be done have been reported as particular
difficulties by Morgan and Klein (2000) [15].
An inclusive work environment is fundamental to
ensuring a satisfactory standard of living for all, and means always keeping in
mind and making the most of everyone's characteristics. It is essential that
the person feels understood and listened to as much as possible and not judged.
In order to eliminate barriers due to discrimination based on stereotypes, it
is useful for there to be knowledge, about dyslexia and what it implies, this
will create a general climate of mutual understanding. Furthermore, creating an
inclusive system not only benefits the person with DSA but will bring positive
consequences for all involved. When inclusive projects are put in place, there
is not only an improvement in internal cohesion within the work group but also
an increase in productivity [14] Beetham and Okhai [14] conducted a study
focused on the development of an inclusion project targeting staff at Imperial
College London. This project involved professors and staff with dyslexia to
take advantage of a coaching service targeted toward their DSA-related needs.
This program showed that eventually participants reported an increase in levels
of self-awareness or self-awareness, improvement in organization and work
performance, more self-confidence and a general feeling of feeling "in control."
The result of the study underscores the need to implement in the work
environment a contact person to whom people with dyslexia can turn and who
protects and promotes access to compensatory tools for workers with ASD. In
addition, Costantini [16] pointed out
that initiatives designed to assist people with dyslexia in developing their
strengths and self-management strategies can be beneficial not only for
adapting to work but also for other types of transitions that may be
experienced in adult life. In Italy to promote inclusion, a recognition for
companies sensitive to the issue, the "Dyslexia Friendly" label, has
been created by AID (Italian Dyslexia Association). The "Dyslexia
Friendly" recognition represents a commitment by the company toward the
inclusion of employees with DSA. This is organized as a twelve-month pathway to
train staff to value people with DSA and promote the use of compensatory tools,
especially at the selection and job placement stage. Thus, this recognition can
be a step in the right direction to raise awareness of dyslexia and inclusion
in work settings among larger companies.
It is also important to understand whether a diagnosis
of dyslexia may influence occupational choice. Indeed, it is possible that
having an ASD may predispose people to opt for some occupations instead of
others [17]. In fact, according to some researchers, low levels of
psychological resources such as self-esteem and self-efficacy, which often
characterize people with ASD, may be an obstacle toward broader occupational
choice [18]. To test whether people with dyslexia tend to choose some jobs over
others, Taylor and coworkers in 2003 [17] conducted research comparing the
occupational choices of adults with and without dyslexia. This analysis showed
a significant difference between the two groups considered. In fact, the group
of people with symptoms of dyslexia had a lower probability of entering
scientific fields such as computer science, management or finance. The
experimenters hypothesized that the reason for this might be the very nature of
these types of occupations. In fact, the jobs listed are characterized by the
use of skills such as writing, number crunching and constantly having very
short deadlines to meet, all skills in which people with dyslexia seem to be
more or less deficient. The data analysis also pointed out that people with ASD
were more likely to be in person-oriented roles such as nursing or buying and
selling. Therefore, it would be interesting to investigate whether this
tendency to avoid certain job categories is due to the characteristics of DSA
or arise from a barrier that prevents people with dyslexia from freely choosing
a job occupation. Furthermore, it is relevant to point out that in addition to
the common difficulties people face during the transition from school to work,
people with ASD often encounter problems related to work culture. In fact,
there is currently found to be a strong difference between the school culture,
which in the last decade has begun to understand people with ASD, and the work
culture where, on the other hand, there is not much information on the topic
[18].
Horn pointed out that people with dyslexia still show
to this day that they are afraid of being discriminated against for their
characteristic by the labor market and that there is a significant difference
between wages of person with dyslexia and among people without any DSA. Madaus
in 2006 [19,20] conducted significant research that highlights how important it
is to have a college degree for people with DSA. Although most students with
dyslexia prefer to go directly from high school to work [21], many decide they
want to continue their educational careers especially in recent years due to
laws protecting their rights to compensatory tools. In fact, data collected by
Madaus show that postsecondary education can be a very important means of
obtaining meaningful employment for people with ASD. For students who had
decided to continue their academic careers, factors such as employment rate and
salary levels were very similar to those of non-SDA persons. They also showed
that they were able to access any type of employment occupation, without any
specific preference. Unfortunately, these data are no longer so favourable when
people with DSA who chose not to pursue post-secondary education are also
considered. In fact, discussing Price and Gerber's 2005 research findings,
where some of the respondents had not gone to college, the investigators state
that people with dyslexia "are often un-employed or under-employed, with
erratic job histories that include multiple entry level jobs with minimum wages
and few benefits." These findings thus lead us to clearly see how much
difference access to postsecondary education can make for people with ASD. To
do so, some authors have highlighted the importance of increasing the use of
assistive technology, defined by Dawson and collaborators in 2019 as
"services and devices that enable people with disabilities to accomplish
daily living tasks; assist them in communication, education, work, or
recreation activities; and ultimately, help them achieve greater independence
and enhance their quality of life." According to recent research, the use
of these tools can greatly improve the quality of education, which will
increase the likelihood of being able to access postsecondary education, which
for people with ASDs can prove crucial [22]. It is therefore critically
important, in order to make all types of work accessible to all, to continue to
protect and guarantee the rights not only of students but also of workers with
dyslexia.
Adults with dyslexia who are unaware of their
condition may often find themselves in jobs below their abilities or
occupations that do not require them to use the knowledge they acquired in
school. Others, however, over time, manage to develop compensatory strategies
to overcome weaknesses and find work appropriate to their skills. In these
cases, however, it should be remembered that the person never accesses
compensatory tools and may face more obstacles in his or her work career.
Having thoroughly understood the issues faced by working adults with ASD, it is
necessary to identify the results achieved. This analysis has revealed a
significant need for a broader process of inclusion and awareness of the issue.
In addition, the literature highlights the need to include within the work
environment a figure who is responsible for ensuring the rights and
compensatory tools for employees with DSA and who can inform as clearly as
possible all workers about what dyslexia is in order to avoid discrimination.
In fact, it is important to make as many people as possible understand what the
symptoms of dyslexia are, how to recognize it, and that these can have a
significant impact on a person's entire life. A representative figure for
workers with ASD could simplify the process of requiring a diagnosis from
adults. Thanks to Law 25 de March 28 [23], many rights are more protected at
work but only for those who can obtain an official certificate. It is essential
to ensure that workers use the necessary compensatory tools and highlight the
strengths that accompany this characteristic to create the most collaborative
environment possible. Thus, we can conclude that an inclusive activity through
the establishment of a reference figure for DSA workers could help contain many
of the issues investigated in this review.