Imagine Jenny, a highly intelligent, extremely hardworking and successful student; she's made it into medical school, where she is scoring top grades as a second-year student. Her instructors comment on her grasp of difficult concepts and also on the depth of her compassion—she's just the kind of person medicine needs. Her story should be a positive one, but it isn't. In order to become a physician, and, indeed, in order to go on to her third year of medical school, Jenny must pass the United States Medical Licensing Exam (USMLE). Logic says there shouldn't be any question about this; however, a recent decision of the test's administrators, the NBME, seems to defy logic and, unless something drastic happens, Jenny will be asked to leave medical school and put an abrupt end to a life of hard work and all of her dreams and her potential contributions to society.
Jenny is dyslexic, and dyslexia robs a person of time. Just as a diabetic requires insulin, an individual who is hearing impaired requires a hearing aid, a man or woman who is a quadriplegic requires a wheelchair, a person who is dyslexic has a profound physiological need for additional time to complete examinations. There should be no ifs or buts, as neurobiological evidence now provides indisputable evidence of the absolute need for extra time for those children and adults who are dyslexic. Cutting-edge, sophisticated functional brain imaging studies clearly demonstrate that the specific brain region (see figure, above right) necessary for rapid, fluent, automatic reading is disrupted in readers who are dyslexic.
Try as hard as they might, young men and women who are dyslexic can only read manually—slowly and with great effort, albeit relatively accurately. Lots of effort plus the provision of the accommodation of extended time on exams levels the playing field for those who are dyslexic, allowing otherwise highly intelligent individuals to demonstrate their knowledge. The provision of extended time ensures that the exam is a measure of the dyslexic person's knowledge and not a measure of his/her disrupted neural system's inability to read fast. Furthermore, data now demonstrate that it is only students who are dyslexic who benefit from additional time. Thus, such college students increase their scores substantially (e.g., 13th percentile to 76th percentile), while typical readers when given extra time on exams increase their scores few to no points (82nd percentile to 83rd percentile).*
You might ask: aren't people like Jenny entitled to the accommodation of extra time on exams; isn't that her right provided by the ADA (Americans with Disabilities Act)? Jenny has a specific neurological condition resulting in disruption of the neural system responsible for fast and automatic reading—shouldn’t that on face value alone qualify her for coverage under the ADA? While reason says yes, the Supreme Court and the testing agencies have ruled otherwise. The problem is that people who are dyslexic can read—and read rather accurately—just not quickly enough so that they can finish in the allotted time period. The testing agencies have chosen to focus solely on these hardworking students' ability to read accurately (otherwise, how would they be able to complete college, attend law, business or medical school), while seemingly ignoring their biological inability to read rapidly. This inability to read rapidly is out of kilter with their overall intelligence, level of education and professional status. As opposed to others of similar intelligence, school, and vocational rank, they cannot demonstrate their knowledge in the standard amount of time allotted on high-stakes exams.
There is no question of Jenny's diagnosis; she has struggled with reading since being presented with her first basal reader and was formally diagnosed as dyslexic in third grade. Since that time, she has received special reading interventions and the accommodation of additional time on exams. This, together with a stalwart work ethic that did not leave time for sports, music, and social activities enjoyed by her peers, allowed Jenny not only to succeed but to thrive academically. Given the additional time, Jenny gave her all, working long hours during the week, on weekends and over what for others were fun-filled holidays. Accordingly, she graduated from high school with honors, and attended college, where she participated in the Learning Center and finished with a 3.6 GPA.
Having experienced illness in her own family, Jenny always dreamed of becoming a doctor and helping others fight off disease. She jumped for joy when she received her letter of acceptance to a well-known Southern medical school. During her first two years, she worked and worked—and she succeeded. Now, in order to enter her third year of medical school, she must not only do well, but she must pass the United States Medical Licensing Examination (USMLE). Otherwise, the rules say her school must ask her to leave, and with that termination, so ends her budding career as a physician. Since the National Board of Medical Examiners has turned down her application for extended time—and she simply cannot read quickly enough to complete and pass the test without additional time—she will fail and be forced to leave medical school. This is definitely not a consequence of a lack of knowledge or commitment, but rather to a documented disability that prevents her from reading automatically and rapidly. Her school is strongly behind her; they know her as a student and as a human being.
Jenny appealed both to the NBME and to the courts, but was turned down by both, with the Court's arguing that since she can read street signs and menus, she is not disabled within the ADA's definition. Clearly, Jenny is disabled—a disability, which if not accommodated, will result in her having to leave medicine.
Beneath the radar, this scenario happens all too frequently to people with dyslexia. In fact, the medical profession is depriving itself of just those individuals whose empathy and creative minds could make a difference. For example, world-renowned heart surgeon and Cleveland Clinic CEO Toby Cosgrove (pictured at left), who is also dyslexic, speaks passionately of his struggles with reading and spelling as a young student. He persevered, worked incredibly hard and succeeded in college. Yet, reflecting his physiologic inability to read quickly, he did not score well on his Medical College Admissions Test (MCAT) and was rejected from 12 of 13 medical schools to which he applied. And had not one medical school overlooked his low MCAT test scores, tens of thousands of patients would not have benefited from the remarkable advancements in cardiac surgery and minimally invasive valve repair, including at least 18 patents, that he has contributed to the world.
Men and women who are dyslexic have given greatly to the cultural, scientific, and judicial life of this country and, in fact, the world. No doubt, there are more students who could be potential Toby Cosgroves or Richard Meiers or Chuck Closes or Stephen Spielbergs or John Irvings, enriching and changing the world; and yet, they will not be allowed to do so. It is not only people in these high-profile professions that are affected by high-stakes exams. Those who want to be master plumbers, nurses, asceticians, teachers, pharmacists, or police officers are also affected, as they, too, have to take and pass a high-stakes examination.
If dyslexics are not permitted extended time on these examinations, the world will be denied the contributions of their talents and they will lose their dreams—all because they cannot read fast enough to pass the inevitable gate-keeper of our society—high-stakes standardized tests. Each of these individuals thinks quickly and creatively, and it is only the printed word that they read slowly.
At Yale University, this website represents the Yale Center for Dyslexia & Creativity, “slow reader; out-of-the-box thinker,” to draw attention to the wonderful sea of strengths in higher-level thinking, reasoning, and creativity that characterize readers who are dyslexic.
Dr. Sally Shaywitz and Rep. Carolyn McCarthy discuss issues relating to dyslexia (Rep. McCarthy is dyslexic and highly supportive of those who are dyslexic) at a recent talk given by the Drs. Shaywitz in the Congressional Rayburn building to Congressional Representatives and their key staff aides.
Congress is considering the ADA Restoration Act right now. If you care, if you want to make a difference, you can help by writing (email) to your Congressional Representative or Senator and tell them you do care and you very much want to see dyslexia included in the ADA Restoration Act.
- Sally Shaywitz, M.D.
* M. K. Runyan, The Effects of Extratime. In S. Shaywitz & B. Shaywitz, eds., Attention Deficit Disorder Comes of Age: Toward the 21st Century; Austin, Texas: Pro-Ed, 1992.