Dyslexia is such a common syndrome that few people are aware that it is a disability recognised under the Disability Discrimination Act 1995 (DDA). As such, it is possible that advice may be sought from the OH service to assist in the management of an employee who experiences the problems that dyslexia brings.
In order to effectively support the employee and give appropriate advice to the employer, the occupational health nurse (OHN) needs to have an understanding of dyslexia, possible strategies to support a worker with dyslexia, and to assist an employer fulfil their duties under the DDA.
The aim of this article is to give OHNs an appreciation of the difficulties facing employees with dyslexia. A case study demonstrates how dyslexia may be manifested in the workplace, with suggested supportive strategies.
The full extent of dyslexia among the population is still being discovered. Most textbooks say 4% for severe dyslexia and 10% for mild dyslexia. However, it could be argued that these figures are convenient statistical cut off points rather than accurately representing the percentage of dyslexics within a sample.
The figures are also beginning to look tired, as we learn the extent to which dyslexia is an umbrella term for a wide range of associated difficulties.
Compensatory strategies can often hide the effects without modifying the nature of the disability. The Dyslexia Scientific American states that 20% of school children are dyslexic,1 although this is a figure more commonly cited in the US than the the UK. The differences in the extent of dyslexia in the US and in the UK may reflect the inclusion of more or less symptoms within the definition of dyslexia or perhaps because of the nature and accuracy of the screening procedure used.
While accurate figures remain a matter of debate, it is clear that given that less than 4% of the general population have been confirmed as having dyslexia, the actual number of people working with dyslexia remains largely undiagnosed within the workplace.
Dyslexia is becoming more widely understood and it is recognised that it is not a result of low intelligence, nor a bar to success. However, many people with dyslexia have to strive even harder to succeed – but succeed they do. People with dyslexia include Albert Einstein and author Linda La Plante.2 Indeed, it has been argued that their creativity is because of, not despite, their dyslexia.3
To assist a worker with dyslexia, it is important that the OHN understands the syndrome of difficulties that are predominantly, but not exclusively, linked to difficulties with the processing of both written and verbal language.
The problems dyslexics have occur along a spectrum from mild difficulties with spelling and number transposition, through to more obvious difficulties in organising their thoughts on paper. It is often associated with problems of sequencing of their ideas, organising their written work and difficulties with time management. According to Demystifying dyslexia, dyslexia is not a defect but an individual difference in cognitive style.2
Worryingly, many teachers and lecturers are failing to recognise dyslexia among their students. Some have the misconception that students who have been positively assessed as having dyslexia require frequent testing to confirm they still have dyslexia, as they may ‘grow out of it’. This is plain nonsense. Unfortunately, once a dyslexic, always a dyslexic.
Dyslexic students benefit by being taught by teachers both knowledgeable of, and sympathetic to, their learning difficulties. Such support can equip them with excellent coping strategies, as well as helping them reach full educational and employment potential.
It is unsurprising that some teachers are failing to appreciate the range of difficulties facing their dyslexic pupils, as dyslexia has only been recognised by many agencies since the 1970s. Demystifying dyslexia refers to the scepticism of the existence of dyslexia displayed by the Department of Education and Science in 1972, in its claim that, “The term ‘dyslexia’ is not susceptible to precise operational definition and serves little useful purpose.”2
Most diagnoses of dyslexia focus on symptoms such as difficulty in learning to read, problems of sequencing information, poor working memory, organisational skills, spelling, motor control and handwriting. These symptoms link to three areas of processing difficulties: visual, auditory and motor integration.5
There is a wealth of theories for their causation. Some argue it is caused by underlying language and phonological deficits.6 Others maintain that it is underpinned by a difference in cognitive style,7 or that it is a problem of automaticity linked to the cerebellum and/or magnocellular neural pathways.8,9 Many of these theories are conflicting, and no consensus about causality has yet emerged.
Dyslexia and the workplace
Dyslexia has implications relating to work performance, accuracy and possible accident proneness. Some dyslexics have most difficulties with visual processing of information, some with auditory processing, and others with motor integration.
Each of these can be severe or mild, and can co-exist in different combinations. For example, motor integration difficulties are often combined with visual processing difficulties. Such symptoms are found inconsistently among individuals who are diagnosed as dyslexic.
Many practitioners argue that there is a range of related strengths found (inconsistently) among dyslexics. These include excellent three-dimensional visual thinking skills, creativity and artistic flair. Consequently, the individual can develop different degrees of compensatory strategies for each of their difficulties, making an accurate diagnosis a complex affair, particularly for adults. When a good working memory and literacy skills are used as (false) markers for intelligence, the social experience of dyslexia can be devastating, particularly when it remains unidentified, and may make sufferers possible targets for bullying.
Dyslexia should not be a bar to employment, but there could be health and safety implications. For example, some people with dyslexia are easily distracted, finding it difficult to focus on one task at a time. Others have difficulty simultaneously processing auditory and visual information. There are obvious implications for a dyslexic worker seeking a career where such processing is integral to the post, such as an air traffic controller.
Where the advice of the OHN is sought, they must compare the requirements of the job to the person’s abilities and difficulties, recommending possible strategies to assist the person to perform effectively in the workplace. The following case study illustrates an OH assessment of a worker and interventions following concerns over work performance.
John was 25 years old and had been employed for six months in a high-pressure accounts department. His manager referred him to OH, as a consequence of John’s high level of repeated short-term sickness absence, coupled with poor work performance.
The manager was exasperated by John’s repeated clerical and arithmetic errors despite using a calculator or spreadsheet programme for calculations. He believed John was disorganised and that he could not be trusted to carry out the requirements of his job and was now a liability in the department.
Every piece of work he produced was checked for accuracy. John agreed he made unexplained errors, but felt his manager’s attitude resulted in him becoming very stressed and making even more errors. John was now to be disciplined for poor performance.
The assessment process
On referral, background information was obtained, including:
- occupational and social history
- past health history, current health status and details of his absences from work
- John’s work requirements
- details of John’s working relationships with his manager and colleagues.
There was nothing of note regarding his past health and occupational history, although his unhappiness at work resulting from a deteriorating relationship with his manager was significant. John felt he was being bullied, which exacerbated his work difficulties. He expressed concerns that he was about to be disciplined and feared the financial implications of losing his job.
The OHN is an impartial adviser to both management and employee. As such, strategies to support John were explored and the manager was informed as to how some of John’s difficulties could be addressed.
John used a computer for much of his working day and as such was defined as a display screen equipment (DSE) user under the Display Screen Equipment Regulations 1992.
It became apparent that he was experiencing difficulties using spreadsheets. He said that when entering data, the numbers on his screen seemed to jump around and he found it difficult to focus on the data entry task. He revealed that his manager was always “having a go at him”, and had labelled him as being semi-literate due to his poor spelling, his tendency to transpose numbers during data entry, and had handwriting which colleagues found difficult to decipher. Not surprisingly, this was demeaning and caused him considerable embarrassment.
He went on to say that the more he tried to write legibly, the harder he found it, and indicated that he had always found writing by hand both difficult and tiring and was frequently berated for this by his school teachers.
Although John was a DSE user, his workstation had not been risk assessed. He was also unaware that he was eligible for an eyesight test paid for by his employer. These were duly arranged.
Further issues to address were:
- possible reasons contributing to, or underpinning, John’s poor performance
- the stress John stated that he was experiencing at work
- the range of interventions required to both support John and give appropriate advice to his manager
- identification of other agencies from whom advice could be sought.
The OHN was aware of the existence and requirements of policies, such as those covering mental health, bullying and harassment, and work with display screen equipment.
She explored the issues of John’s relationship with his manager and his concerns of being bullied, with the aim of empowering him to work assertively with his manager and colleagues. As part of their discussions, she asked John which agencies he felt he could approach within the organisation for further support. He suggested seeking advice from his trade union and the OHN agreed that this might prove a useful strategy.
As John had mentioned that images on the screen seemed to “jump around”, one of the first interventions was a DSE risk assessment.
The assessment included observing the use and adjustments of John’s computer, the clarity of the image on his screen, possible sources of glare, and the suitability of workplace lighting. When the assessment revealed that the lighting was suitable and sufficient, considering the tasks he undertakes as part of his job, and that there was no evidence of glare or reflections on his DSE screen, John was shown how to adjust the contrast and brightness controls to improve the visibility of the image on his screen.
Although the image was clear and stable, he still found it difficult to enter data as he had difficulties focusing on the image on his screen. The DSE assessor confirmed that there was no evidence of any abnormality of the image on the screen, and an assessment of John’s visual acuity revealed that there were no problems with any aspect of his visual acuity.
The OHN reflected on the above findings and considered other causes for John’s problems with data entry. John’s declared problems with handwriting, spelling and the transposing of numbers led the OHN to suspect dyslexia.
This was discussed with John, who discounted it as he was under the misapprehension that people with dyslexia are of low intellectual ability and could not read or write. The OHN reassured him that this is not the case and suggested that an assessment may prove useful, as it could explain his difficulties. It was stressed that a specialist agency may also be able to make recommendations in order that he could be supported in the workplace. John agreed to such a referral, as he considered that if he was dyslexic, such recommendations may assist him to keep his job.
The psychologist concluded that John met the criteria for dyslexia as he had strengths in verbal and quantitative reasoning, had a number of weaknesses characterised as visual processing and motor integration difficulties.
Although his reading and basic number skills were at expected levels, his spelling skills were significantly weaker than expected. The difficulties John was having with transposing numbers on screen, placing the decimal points in the wrong place and subsequent miscalculations, were a consequence of his motor integration and visual processing difficulties. He would make typing errors without realising that he had done so. He was then unable to identify his errors accurately through scanning or proof reading.
Spreadsheets made this problem worse by placing numbers in columns without locating value in vertical columns. For example, writing 102.66 would be placed directly over 23.8, such that the position of the decimal point varied according to the number of digits to the right of the decimal point rather than the value. John would find it difficult to see where the decimal points were placed. John’s reading difficulties were a consequence of Meares-Irlen syndrome10 – the numbers appeared to move on the screen.
Dyslexia underpinned his poor performance at work, which was probably further exacerbated by his manager’s behaviour. With John’s agreement, a response to management was made to this effect and recommendations made to assist John in the workplace.
John’s difficulties reading images on his DSE screen were addressed by identifying an appropriate background screen colour for John, and by changing the font, colour and size of the numbers. This reduced errors and made proof reading more accurate. While this reduced the problem, it did not eliminate it. Introducing a screen reader that read back the numbers as John wrote them (or on demand) eliminated it by providing a double check that he was making no unintentional errors at the input stage. As John’s numerical reasoning was good, this combination of strategies meant that he was able to compensate well for his specific difficulties.
John was referred for specialist advice so that he became more aware of both his strengths and weaknesses. This made it possible for him to compensate for his difficulties. Previously, for example, he was unaware that his proof-reading skills were inadequate to meet the demands of his job. Once he understood the mechanism, he had the confidence to negotiate with his employer. However, it remained important that his line manager also understood John’s strengths and weaknesses so that his capabilities were not undermined.
Handwriting will always remain a problem for John, due to his motor-integration difficulties. In John’s case, it was important to recognise that very little handwriting is required for the job. Understanding that the handwriting problems were a consequence of specific motor-integration difficulties, transformed the way they were seen by his colleagues, and they were no longer misinterpreted as a lack of care or ability. Many people who have difficulties writing legibly address this by learning to touch type or using voice-recognition software.
This article gives an indication of the extent of the problem and the difficulties facing employees with dyslexia. Although it is not the remit of the OHN to diagnose dyslexia, they should be aware of how it may manifest itself in the workplace. Agencies that may be able to confirm this condition can recommend possible support strategies so that modifications are both suitable and sufficient to assist the employer to comply with the Disability Discrimination Act 1995.
Anne Harriss is a reader in educational development and course director for BSc (Hons) Occupational Health Nursing at London South Bank University.
Ross Cooper is director of the Dyslexia & Literacy Division, LLU+ at London South Bank University (LLU+ is a national consultancy and professional development centre for staff working in the areas of literacy, numeracy, dyslexia)
1. Shaywitz, S (1996) Dyslexia Scientific American, November 1996, p78-84
2. Krupska, M and Klein, C (1995) Demystifying dyslexia. London. The London Language and Literacy Unit
3. West T (1991) In the Mind’s Eye. Buffalo, US. Prometheus Books
4. Davis, R (1995) The Gift of Dyslexia. London. Souvenir Press Books
5. Klein, C (1993). Diagnosing Dyslexia: a guide to the assessment of adults with specific learning difficulties. London: Adult Literacy & Basic Skills Unit
6. Stanovitch, KE (1988) Explaining the differences between the dyslexic and the garden-variety poor reader: the phonological core variable-difference model. Journal of Learning Disabilities, 21(10), p590-604, 612
7. Morgan, E and Klein, C (2000) The Adult Dyslexic in the Non-dyslexic World, London. Whurr
8. Stein, J and Walsh, V (1997) To see but not to read: the magnocellular theory of dyslexia. Trends in Neuroscience 20 (147) p152
9. Fawcett, A and Nicholson, R (1999) Developmental Dyslexia: The Role of the Cerebellum. Dyslexia Vol 5 Number 3 p155-177
10. Robinson, GL (1994) Coloured Lenses and reading: A Review of Research into Reading Achievement, Reading Strategies and Causal Mechanisms. Australian Journal of Special Education 18 (1), p3-14