accomodationAlthough recent scientific research has shed light on the biological basis of dyslexia, many students with dyslexia face practical hurdles, one of the most recent in the news, a Yale medical student recently denied extended time accommodations by the United States Medical Licensing Exam for his medical boards.


Word Skips and Reading Mistakes on Test Questions 

A major source of difficulty for dyslexic students occurs with misreading of test questions. Dyslexics are likely to miss small words ‘non-content’ words such as prepositions or modifiers so that re-reading of questions is necessary to accurately register what questions are being asked. From MacDonald’s Critchley’s Dyslexia Defined, “Sexton has quoted two typical examples of mathematical problems where a dyslexic, by skipping a simple preposition, missed the complete significance of the question and perpetrated gross errors in interpretation…”What will be the volume of gas if the pressure is reduced to 18 lbs per square inch”, all four dyslexics who tackled the question omitted to notice the word “to”. Because most standardized test questions are designed to determine misinterpretations of word problems such as this, dyslexics may be tripped up by questions if they aren’t given enough time to re-read questions and catch their errors. Test instructions are also a bane for many dyslexic students. From Eileen Simpson’s Reversals, “At the top of the first page was a long, dense paragraph of instructions. Instructions had always caused me particular trouble. So much was said in so few words that what was intended was rarely clear…I recognized most of the words, but what did they say to do?” Because test instructions are non-contextual and many dyslexics fill-in meaning by context, instructions or test questions in general may be the most difficult reading that students will have on an exam. One high school dyslexic told us, “I do fine with taking tests in school, because I know the questions are based on what we’ve been studying in class. But when it came to the PSAT, I couldn’t be sure what the reading passages were about.”

Visual Fatigue and Visual Crowding Errors – Scantron

For some students, visual fatigue and visual overload are the worst aspects of taking standardized exams. Students with dyslexia also are more sensitive to visual crowding so that they will have more trouble than other students completing bubble-in tests, and not putting their marks in the wrong bubbles. For many students, the 3 ½ hour SAT will be the longest period of time they have had to sustained their visual focus.

With fatigue, dyslexics are more likely to make visual fixation slips, reverse numbers, or even letters in multiple choice questions.

Reading Speed

For many dyslexics, slow reading speed and the need to re-read questions and instructions due to word skips results in a gross underestimation of their knowledge on timed tests. In general we recommended double time for dyslexics on the SAT or ACT because of the long duration of the tests and the inevitability of more visual errors occurring as students become fatigued.

An additional important factor to keep in mind is that some students may need the Nelson Denny test to confirm their difficulty with reading speed on college-bound tests. The problems with some of the simpler tests of reading comprehension (WIAT-II for instance), is that students may have fairly normal reading speeds with less challenging reading passages, but really be slowed when the complexity of word usage and syntax increase. The Nelson-Denny test uses college level reading samples to assess reading speed.

For those who wonder whether extended time for dyslexics students will create an unfair advantage over non-dyslexics, studies have shown that extended time does not provide any advantage to non-reading-impaired readers, but it does provide a more accurate assessment of the knowledge and thinking abilities of reading-impaired students.

Difficulty with Multiple choice Questions

In 2008, a UK medical student protested the common practice of multiple choice questions in doctors’ training. In common practice, doing away with multiple choice questions is a difficult task for overburdened undergraduate and graduate faculty – essays, practicals, and oral testing are much more time-consuming to carry-out and grade. In the article above, some dyslexia experts suggested that visual factors are responsible for some dyslexic students’ difficulty with multiple choice formats, but we would add two additional factors.

First, some dyslexics students are highly divergent thinkers. As a result, they may ‘overthink’ questions by reading too much into either the questions or thinking about unusual exceptions. Divergent thinking is valuable for many types of high level creative thinking, but it isn’t always the most beneficial processing style to have for a multiple choice test written in a very convergent fashion.

Second, many dyslexic students seem to file words in the less precise, but more association-rich right hemisphere. As a result, they may be more to misinterpreting the wording of concise multiple choice questions, and yet be able to expand and fully substantiate their knowledge of course material on oral testing.

Writing Problems

Finally, for many students, the hardest part of college entrance exams will be the writing sections for the SAT or ACT. Writing is the most difficult task for almost all college-attending and adult dyslexics because of a wide range of factors, but most notably language related factors (word retrieval, syntax, conventions, spelling), mechanical factors affecting the ability to write letters in an ‘automatic’ fashion, and working memory overload.

Dyslexic students really benefit by test preparation before high-stakes tests, especially opportunities to view and analyze others’ essays (so they know more what’s expected of them), practice writing to the rubric, and be familiar with the types of questions asked. Extra time is essential because of sequencing challenges, working memory overload errors (e.g. missed words or letters), and need to correct spelling, grammar, and punctuation mistakes. Most students would benefit from keyboard accommodations because their letter writing is not automatic. If keyboard accommodations are not approved, a students written product may show many more ‘careless’ errors and spelling and grammar mistakes.

Again, from Simpson’s book, the writing burden of dyslexia is poignantly expressed: “My written vocabulary, limited as it was to words I thought I had a chance of spelling correctly, allowed me to express my ideas in only the most simplified way. What I put down on paper, with anxious impatience, seemed to me so childish that after a paragraph or two I ran dry…I’d put something down…cringing at the way it exposed my illiteracy, hand it in.”

Documentation Requirements for Disability Accommodations on the PSAT, SAT, or ACT

Visit  the Dyslexic Advantage Resource Library for Middle and High School Students with Dyslexia.