Dyslexia and dysgraphia are the two Neurodevelopmental Disorders which including others such as Autism Spectrum Disorder, ADHD, Intellectual Disability are termed as neurodevelopmental disorder that affects the way children process phonological and linguistic information including word recognition.

Dyslexia is a neurodevelopmental disorder characterized by difficulties in reading, spelling, and decoding, despite adequate intelligence and educational opportunities. Primary dysfunction is in impaired phonological processing leading to slow reading and/or misreading words and affects their reading comprehension and fluency.

It I s estimated that around 5-15% of the general population are affected by this condition. Children suffering from it have difficulties in phonological processing (ability to manipulate and analyze the sounds of language) and word recognition and production. Left hemisphere of the brain related to language processing for example, Broca’s area, Wernicke’s area, and angular gyrus are involved in Dyslexia.

Dyslexia and dysgraphia are complex neurodevelopmental disorders that significantly affect the way children process phonological and linguistic information including word recognition, processing. This condition results in difficulties with reading, writing, and spelling, which can significantly impact a child’s academic performance and self-esteem. Unlike other learning disabilities, dyslexia is not linked to intelligence; rather, it involves differences in the way the brain processes written and spoken language. In regions like Nepal and South Asia, cultural and educational challenges, lack of awareness and stigma make the issue more complicated to identify and intervene. Dyslexia, often characterized by difficulties in reading and phonological processing, and dysgraphia, marked by poor handwriting and spelling, are influenced by genetic, psychological, neurobiological, and environmental factors. In country such as Nepal, understanding the signs and symptoms of learning disorders like dyslexia and dysgraphia, alongside strategies for early diagnosis and intervention, is critical in creating inclusive education systems in Nepal and across Asia. Topics such as assistive technology, dyslexia-friendly fonts, teaching strategies for learning disorders, and improving handwriting in children with dysgraphia are central to addressing these challenges.

Presentations

Dyslexia mainly affect the way children acquire linguistic abilities including reading, spelling, and decoding verbal and written language, it manifests in a complex manner. Some children have more difficulties in writing whereas others may have difficulty spelling and reading written materials correctly.

Some forms of Dyslexia are

1. Letter Reversal: Writing “b” as “d,” or “p” as “q.” Example: Writing bog instead of dog.
2. Phonetic Spelling: Spelling words as they sound. Example: Writing fizics instead of physics or laf instead of laugh.
3. Letter Omission: Leaving out certain letters in words. Example: Writing frind instead of friend.
4. Unusual Spacing: Difficulty with consistent spacing between words. Example: Writing mydogis big instead of my dog is big.
5. Mirror Writing: Writing some letters or numbers backward. Example: Writing Ɩ for 1 or E for 3.
6. Sequencing Errors: Mixing up letters or syllables in longer words. Example: Writing freind instead of friend or psghetti instead of spaghetti.

Dyslexia may manifest in other important different ways:

1. 1. Phonological Dyslexia

      This is the most common type of dyslexia. Individuals struggle with phonemic awareness, which is the ability to break down words into smaller sound units (phonemes). They may find it hard to decode unfamiliar words and match sounds to letters. Examples of Phonological Dyslexia are children struggling to read a word like cat by sounding out the individual letters “c”, ”a”, “t” and reading “c—aaa—tt—”

   2. Surface Dyslexia

      People with surface dyslexia rely heavily on phonetics and may struggle to recognize whole words quickly or understand irregular spellings. They face difficulties with words that do not follow typical phonetic patterns for example island or yacht. A child can read yacht as ya—ch—t instead of recognizing a whole word such as “Is-lan-d” for island.

   3. Visual Dyslexia

      Children with this form of dyslexia have difficulty visually processing similar looking letters or words such as they may mistake b for d writing bog instead of dog

   4. Auditory Dyslexia

      Here children process sounds incorrectly leading to confusion with similar sounding words or phonemes such as mishearing pen as pin or cot as cut or pronouncing “pet” as “pit”

   5. Double Deficit Dyslexia

      In this type a combination of issues with phonological processing can occur with rapid naming, or making reading extremely slow and laborious. Children with this type of dyslexia may read home as house or dog as

   6. Deep Dyslexia

      This is a rare type of dyslexia and occurs mostly following a brain injury. Individuals make errors in semantic associations, substituting one word for another with similar meaning. For example, reading home as house or dog as 

   7. Dysgraphia (Writing-related Dyslexia)

      Dysgraphia is a condition where individuals have difficulty writing. It is not exactly a type of Dyslexia, where the primary dysfunction is in reading ability, Dysgraphia is characterized by difficulty in writing, including handwriting, spelling, and written composition. These individuals have problems with fine motor control, memory retrieval, and organizing thoughts in writing. Individuals suffering from dysgraphia have challenges in writing assignments, slow or effortful handwriting, and often show frustration when trying to put ideas into written form.

Etiological Factors

As most of other mental health conditions, Dyslexia has a multifactorial etiology, and seems to arise from a combination of neurobiological, environmental, and psychological factors.

Neurobiological Factors

Research indicates that dyslexia is strongly associated with differences in brain structure and function. Advancement in neuroimaging led to studies which have consistently shown that individuals with dyslexia often exhibit atypical activity in the left hemisphere of the brain, particularly in areas responsible for language processing, such as the Broca’s area, Wernicke’s

area, and the occipital-temporal region. Advanced neuroimaging techniques have revealed alterations in the internal capsule, a paired white matter structure, as a two-way tract, carrying ascending and descending fibers, to and from the cerebral cortex. It is located in the inferomedial part of each cerebral hemisphere of the brain. It carries information past the subcortical basal ganglia, separating the caudate nucleus and the thalamus from the Putamen and the globus pallidus. These fibers also separate the caudate nucleus and the putamen in the dorsal striatum, a brain region involved in motor and reward pathways. These brain regions seem to “malfunction” due to genetic influences.

Genetic Factors

Studies have identified 35 gene variants influencing dyslexia, emphasizing its multifaceted etiology. It shows Dyslexia has a strong genetic component, with heritability estimated at approximately 50%. Studies have pinpointed specific genes, such as KIAA0319, involved in brain development and neuronal migration. Genetic variants associated with dyslexia also overlap with those linked to attention-deficit hyperactivity disorder (ADHD) and other neurodevelopmental conditions.

Environmental Factors

Although, genetic and neurobiological basis of Dyslexia have been well established and still being vigorously studied, environmental factors play a crucial role in the manifestation and severity of dyslexia. Factors such as parental education, early exposure to language, quality of education, verbally rich social environment and socio-economic status can impact a child’s reading development. Children who grow up in language-rich environments with supportive educational resources are less likely to experience severe dyslexic symptoms compared to those with limited access to such resources.

Prenatal exposure to nicotine, alcohol, maternal infections, and neonatal hyperbilirubinemia have also been identified as risk factors. The level of maternal stress and anxiety during pregnancy also has been found to increase the risk for all neurodevelopmental disorders including dyslexia.  Level of stress hormone during pregnancy can impact fetal brain development which may advertently affect brain development and so does level of nutritional deficiencies, infection during pregnancy, and other myriad of environmental factors.

Low birth weight, premature birth, birth complications leading to diminished oxygen levels in the infant also play an important role in neurodevelopmental disorders.

Psychological Factors

Psychological factors, including anxiety, self-esteem, and motivation, can exacerbate the challenges faced by individuals with dyslexia. Children who struggle with reading may develop negative attitudes towards school and learning, leading to a cycle of frustration and avoidance. Supportive interventions that address these psychological components are essential for helping dyslexic individuals succeed academically and emotionally.

Diagnosis

The symptoms of dyslexia can vary widely among individuals, but common signs include difficulties with phonemic awareness, decoding, reading fluency, and spelling. Early identification and diagnosis are crucial for implementing effective interventions.

ICD-11 Dyslexia is categorized as under “Developmental Learning Disorder with impairment in Reading”. This includes persistent difficulties in reading accuracy, fluency, and comprehension, which are not explained by intellectual disabilities, sensory impairment or inadequate educational opportunities.

DSM-5 lists Dyslexia under Specific Learning Disorder (SLD) with a specifier for reading impairment.

The DSM-5 outlines the following criteria for SLD with impairment in:

Persistent difficulties in word reading accuracy, reading rate or fluency, and reading comprehension for at least six months, despite targeted interventions.

The difficulties are substantially below what is expected for the individual’s age and interfere with academic or occupational performance.

The onset of symptoms occurs during school-age years but may not fully manifest until academic demands exceed the individual’s abilities.

The difficulties are not better explained by intellectual disabilities, uncorrected sensory impairments, or other mental or neurological disorders.

Management of Dyslexia and Dysgraphia

Managing dyslexia involves a comprehensive approach that combines educational techniques, assistive technology, psychological support, and accommodations tailored to individual needs. Phonics-based instruction, such as Orton-Gillingham or Wilson Reading System, is a structured, multisensory method that focuses on decoding, spelling, and fluency. Structured literacy programs also emphasize explicit teaching strategies to help dyslexic individuals improve reading skills. Assistive technologies like text-to-speech software and dyslexia-friendly fonts provide critical support, enabling individuals to access written material with greater ease. Psychological support is equally vital, as dyslexic individuals often face emotional challenges, including anxiety and low self-esteem. Building confidence through therapy, counseling, and peer support groups can significantly improve their resilience. In educational and workplace settings, accommodations such as providing extra time for reading tasks, flexible assessment methods, and teacher training play an essential role in fostering a supportive environment.

Dysgraphia, on the other hand, requires strategies to address handwriting, spelling, and written composition difficulties. Handwriting practice and motor control exercises can help improve fine motor skills, while encouraging the use of typing over handwriting reduces frustration during written tasks. Visual aids like lined paper and letter tracing are beneficial for developing consistent handwriting. Assistive technology also plays a key role, with speech-to-text programs allowing individuals to dictate instead of writing, and smart pens converting handwritten text into digital formats. Psychological and cognitive support is crucial for individuals with dysgraphia, as frustration is common during writing tasks. Occupational therapy can address fine motor challenges, while organizational tools like graphic organizers help individuals structure their thoughts for writing assignments. In educational and workplace environments, accommodations like extended writing time, providing printed notes, and offering alternative methods for expression, such as oral presentations, are essential in supporting individuals with dysgraphia.

Both dyslexia and dysgraphia require tailored interventions, and no single approach works for everyone. The key is to customize strategies based on the individual’s strengths and challenges, combining tools and techniques to create an environment where they can thrive. Let me know if you’d like to explore any specific aspect further!

Dyslexia in Nepal

A study conducted in 2024, on a sample of 1661 students of grade V and grade VI, authors found that prevalence of dyslexia was 8.97% (10.42% in males and 7.90% in females).

One post in reddit, a person, posted which I am copying here with the link to the original post. This post succinctly summarizes the status of suffering and lack of proper identification and management of Special Learning Disabilities in Nepal.

“I’m frustrated with the education system in Nepal. As someone with dyslexia, I had an incredibly tough time in school. The Nepali education system made it even harder because it doesn’t recognize any learning disabilities yet.

I’m currently in university and writing a stand-up skit about my struggles with dyslexia in school. Looking back, it’s all just a funny story now. Dyslexia doesn’t magically go away after you leave school, but you do get somewhat used to it.

However, there are probably lakhs of people still struggling with dyslexia in Nepal, and most of them don’t even know what it is. They often just think they’re stupid, and their teachers certainly don’t help them.

I needed to vent after all the thinking I’ve done today, but I also want to find a solution to”

However, at present schools such as The British School, Nepal, CMC Nepal, CMCS Nepal, TPO Nepal, and CPH Nepal offer professional help including the diagnosis and management for Specific Learning Disorders such as Dyslexia and Dysgraphia. Kanti Children’s Hospital is now a leading government hospital which has both Child Psychiatrists and Clinical Psychologists who specialize in Specific Learning Disabilities.

Conclusion

Dyslexia is a multifaceted neurological disorder that requires a comprehensive and individualized approach to diagnosis and intervention. By understanding the neurobiological, environmental, and psychological factors that contribute to dyslexia, educators, parents, and clinicians can provide the support and resources necessary to help dyslexic individuals thrive. With early identification and targeted interventions, children with dyslexia can overcome their reading and writing challenges and achieve their full potential. dyslexia and dysgraphia are learning disorders that demand a comprehensive approach involving education, assistive technology, and emotional support. Key areas of focus include phonics-based instruction for dyslexia, occupational therapy for dysgraphia, and inclusive teaching strategies for children with learning disabilities in South Asia, including Nepal. Raising awareness about early intervention, building inclusive classrooms, and fostering resilience through psychological support can transform the lives of individuals with these conditions. Emphasizing culturally relevant interventions, such as improving handwriting in Nepalese children, multilingual education, and overcoming stigma around learning disabilities in Asia, ensures a holistic approach to literacy and education.

Read More on Neurodevelopmental disorders in Nepal

Autism in Nepal
Children of Nepal
Autism: Parents should take charge
Neurodevelopmental Disorders in Nepal

References

1. 1. 1. 1. 1. Mirela Duranović, Lidija Kobelja, Matea Andrejaš (2024). “Environmental Risk Factors in Children with Dyslexia.” Published in Research in Education and Rehabilitation. Read here.
            2. Mirela Duranović, Lidija Kobelja, & Matea Andrejaš. (2024). ENVIRONMENTAL RISK FACTORS IN A CHILDREN WITH DYSLEXIA. Research in Education and Rehabilitation, 7(1), 88–104. Retrieved from https://rer.ba/index.php/rer/article/view/188
            3. Michelle Luciano et al. (2022). “Gene Study Identifies DNA Variants Linked to Dyslexia.” Published by the University of Edinburgh. Read here.
            4. University of Edinburgh. “Gene study identifies series of DNA variants linked to dyslexia.” ScienceDaily. ScienceDaily, 20 October 2022. www.sciencedaily.com/releases/2022/10/221020112823.htm
            5. Doust, C., Fontanillas, P., Eising, E. et al. Discovery of 42 genome-wide significant loci associated with dyslexia. Nat Genet, 2022 DOI: 10.1038/s41588-022-01192-y
            6. Bartosz M. Radtke et al. (2024). “Developmental Dyslexia in Children with Perinatal Exposure to Hypoxia: A Systematic Review.” Published in PLOS ONE. Read here.
            7. Radtke BM, Lipowska M, Bieleninik Ł, Łada-Maśko A, Krempla-Patron K, Nowicki R, et al. (2024) Developmental dyslexia in children with perinatal exposure to hypoxia: A systematic review. PLoS ONE 19(9): e0308497. https://doi.org/10.1371/journal.pone.0308497
            8. Stefan Samuelsson & Ingvar Lundberg (2003). “The Impact of Environmental Factors on Components of Reading and Dyslexia.” Published in Annals of Dyslexia. Read here.
            9. Arrindell, W. A., Perris, C., Perris, H., Eisemann, M., Van der Ende, J., & von Knorring, L. (1986). Cross-national invariance of dimensions of parental rearing behavior: Comparison of psychometric data of Swedish depressives and healthy subjects with Dutch target ratings on the EMBU. Bristish Journal of Psychiatry, 148, 305–309.
            10. Samuelsson, S., Lundberg, I. The impact of environmental factors on components of reading and dyslexia. Ann. of Dyslexia 53, 201–217 (2003). https://doi.org/10.1007/s11881-003-0010-8
            11. Yanhong Huang et al. (2020). “Personality, Behavior Characteristics, and Life Quality Impact of Children with Dyslexia.” Published in International Journal of Environmental Research and Public Health. Read here.
            12. Huang Y, He M, Li A, Lin Y, Zhang X, Wu K. Personality, Behavior Characteristics, and Life Quality Impact of Children with Dyslexia. International Journal of Environmental Research and Public Health. 2020; 17(4):1415. https://doi.org/10.3390/ijerph17041415
            13. Fumiko Hoeft & Florence Bouhali (2022). “Pre- and Postnatal Environmental Effects on Learning to Read and Mathematical Learning.” Published in The Cambridge Handbook of Dyslexia and Dyscalculia. Read here.
            14. Hoeft F, Bouhali F. Pre- and Postnatal Environmental Effects on Learning to Read and Mathematical Learning. In: Skeide MA, ed. The Cambridge Handbook of Dyslexia and Dyscalculia. Cambridge Handbooks in Psychology. Cambridge University Press; 2022:115-150.
            15. Clyde Francks & Sourena Soheili-Nezhad (2024). “Breakthrough Study Sheds Light on the Complex Brain Science Behind Dyslexia.” Published in The Debrief. Read here.
            16. Kunwar, R., G. C., L., Dahal, P. P., & Thapa, K. B. (2024). Unveiling the silent struggle: Exploring the influence of dyslexia on elementary students’ mathematics learning in Nepal. Eurasia Journal of Mathematics, Science and Technology Education, 20(7), em2474. https://doi.org/10.29333/ejmste/14752