**2. Awareness of dyslexia in Hong Kong**

There has been a growing awareness of the issues of children with dyslexia in Hong Kong since the 1990s.

As dyslexia is often termed as "hidden disability" due to the discrepancy between the intellectual abilities and actual reading and writing performance, under-diagnosis and hence deprivation of early identification and early interventions such as appropriate educational and social support from teachers and parents usually exist (Department of Social Work and Social Administration, 2005).

Currently, there is no reliable prevalence rate of dyslexia. As the knowledge on dyslexia of the major stakeholders is limited, the report rate of dyslexia remains low in Hong Kong. However, over 80% of primary and secondary school teachers come into contact with dyslexic students in their classes. Although primary and secondary school teachers have adequate basic knowledge on dyslexia, the majority desired more in-depth training on its nature and management (Hong Kong Christian Service, 2005). This reflects that there has been a lack of training on dyslexia for personnel working with children which may have made early identification and subsequent interventions of dyslexia less possible.

A study showed that 62.5% of parents suspected that their children were suffering dyslexia, with only 21.6% being identified by their teachers. About 70% and 25% of students were assessed in Child Assessment Centers and in schools (either by Education Bureau, EDB, or school-based educational psychologists) respectively. The long waiting time for assessment services was also an issue. About one-third of students waited for 3 to 6 months; nearly 40%

Dyslexia in Hong Kong: Challenges and Opportunities 33

effective in the treatment for dyslexia. Considerable lower percentage of respondents in both studies gave correct answers to other two questions, namely, "Hyperactive students will have various degree of dyslexia" and "All dyslexic students suffer problem of inattention". The correct answers for both should be "false". The possible explanation for the misconception is likely to be the common occurrence of attention-deficit/hyperactivity disorder (ADHD) and dyslexia and the relationship between the two disorders being mistakenly perceived to be causal instead of comorbid. The comorbidity of ADHD and dyslexia is well recognised. A meta-analysis study indicates that pharmacological interventions (mainly the use of stimulants) are more effective than non-pharmacological interventions in treating ADHD but still not significant in improving academic performance. As ADHD is wrongly perceived to be the cause of dyslexia and medication is found to be effective for ADHD, one may conclude that medication will thus be effective for dyslexia. The possible reason of better performance of teachers in this question is that they may misunderstand that the medication prescribed is used for the co-existing ADHD problems. Hence, when the teachers notice that dyslexic problems cannot be improved by the

medication, they may well believe that the medication is ineffective for dyslexia.

**3.1 The Hong Kong Association for Specific Learning Disabilities (HKASLD)** 

• creating a better and fairer school environment for their own children;

• providing both emotional and instrumental support to other parents;

• to advocate for better learning environments for children with SLD.

advocacy, children and youth development, and public education.

• implementing educational events for the general public.

in solving problems faced the children with SLD;

SLD and hence eliminate the discrimination;

• to encourage professional research;

become more structural and precise. They include:

The following parts summarize the report written by the chairperson of a renowned parent

HKASLD is a parent self-help group established in 1998. Before the 1990's, either the government or the general public had very little attention on specific learning disabilities (SLD). Even parents and teachers were not aware that academic underachievement might be due to SLD. Worse still, children with SLD were regarded as lazy and hence ignored and neglected in schools. In view of this, a group of parents organized HKASLD with the

• improving education policies pertaining the provision of assistance to children with

After more than a decade of development and experiences, the objectives of HKASLD

• to facilitate self-help and mutual-help among parents in order to better assist each other

• to promote the general public understanding and acceptance towards children with

The work of HKASLD is comprehensive which includes parent support and education,

**3. Actions taken in the past two decades in Hong Kong** 

group, HKASLD (Ngan-Keung, 2008).

following aims:

SLD;

had to wait for 6 months to one year, and more than 10% even needed more than one year. As a result, parents ought to shoulder a crucial gate-keeping role in early identification so as to initiate the subsequent professional assessment and interventions (Ngan-Keung, 2008).

When parents suspect their children of dyslexia, it is quite common and natural for them to want to know more about its causes, treatment/interventions and prognosis. Accurate and reliable information on dyslexia is best provided by well informed professionals. While various personnel are involved in identification of dyslexia, nurses are usually one of the most readily accessible frontline professionals who provide advices for children's healthrelated problems. Hence, nurses with knowledge on dyslexia act as a gate keeper for early detection of dyslexia before referring suspected children for further assessment. In Hong Kong, the Student Health Service of the Department of Health (DH) provides comprehensive health programs for primary and secondary school students according to their needs at various developmental stages. Nurses there are responsible for physical examination and health assessment, individual counseling and health education activities as well as referring those with problems to Special Assessment Centre or specialties for further assessment and management. Children suspected of dyslexia can be referred for comprehensive child assessment provided by DH, EDB or private agencies (Hong Kong Department of Health, 2006).

In response to the need to investigate the knowledge on dyslexia among health-care professionals, there was a study (Tsui, 2007) to get a profile of Hong Kong nursing students' knowledge on dyslexia by using ten true/false questions covering basic knowledge on dyslexia. It aimed to find out the implications for nursing education for both nursing students and practicing nurses as well as for current and future nursing practices. Those ten questions which were also adopted in an earlier study on Hong Kong teachers' dyslexia knowledge were designed by Dr. Catherine Lam, a leading advocate for dyslexics in Hong Kong and the consultant of Child Assessment Service of Department of Health. The comparison of the knowledge of the nursing students and the teachers in the two studies respectively was also made. With each correct answer of the ten questions scoring one, the mean was 7.71 in the study on nursing students which was lower than that in the study on teachers. More than 90% of the teachers gave a correct answer in eight out of ten questions whereas of the nursing students scored more than 90% in only three out of ten questions. Performance of the teachers was better than that of the nursing students in three questions. They were "Dyslexia is related to a lack of parents' supervision", "Dyslexia is related to a lack of motivation for learning" and "Dyslexia will usually improve when student grows up". The answers of all these questions were "false". This was expected as teachers were more informed about such situations. They usually had regular contact with parents for discussing students' academic performance. They were probably aware that no strong correlation existed between parents' supervision and the occurrence of dyslexia. In other words, dyslexia did occur irrespective of whether parent supervision was adequate or not. Similarly, teachers could readily notice that dyslexia occurred and did not improve though there were children who were eager to learn. As for Question "Medication is effective for dyslexia", over 90% of the teachers in that study but only 74.4% of the nursing students in the present study answered the question correctly (realising the statement was false). Nursing students were expected to be more familiar than teachers with drug therapy but surprisingly over a quarter of them had the misconceived notion that medication was

had to wait for 6 months to one year, and more than 10% even needed more than one year. As a result, parents ought to shoulder a crucial gate-keeping role in early identification so as to initiate the subsequent professional assessment and interventions (Ngan-Keung, 2008). When parents suspect their children of dyslexia, it is quite common and natural for them to want to know more about its causes, treatment/interventions and prognosis. Accurate and reliable information on dyslexia is best provided by well informed professionals. While various personnel are involved in identification of dyslexia, nurses are usually one of the most readily accessible frontline professionals who provide advices for children's healthrelated problems. Hence, nurses with knowledge on dyslexia act as a gate keeper for early detection of dyslexia before referring suspected children for further assessment. In Hong Kong, the Student Health Service of the Department of Health (DH) provides comprehensive health programs for primary and secondary school students according to their needs at various developmental stages. Nurses there are responsible for physical examination and health assessment, individual counseling and health education activities as well as referring those with problems to Special Assessment Centre or specialties for further assessment and management. Children suspected of dyslexia can be referred for comprehensive child assessment provided by DH, EDB or private agencies (Hong Kong

In response to the need to investigate the knowledge on dyslexia among health-care professionals, there was a study (Tsui, 2007) to get a profile of Hong Kong nursing students' knowledge on dyslexia by using ten true/false questions covering basic knowledge on dyslexia. It aimed to find out the implications for nursing education for both nursing students and practicing nurses as well as for current and future nursing practices. Those ten questions which were also adopted in an earlier study on Hong Kong teachers' dyslexia knowledge were designed by Dr. Catherine Lam, a leading advocate for dyslexics in Hong Kong and the consultant of Child Assessment Service of Department of Health. The comparison of the knowledge of the nursing students and the teachers in the two studies respectively was also made. With each correct answer of the ten questions scoring one, the mean was 7.71 in the study on nursing students which was lower than that in the study on teachers. More than 90% of the teachers gave a correct answer in eight out of ten questions whereas of the nursing students scored more than 90% in only three out of ten questions. Performance of the teachers was better than that of the nursing students in three questions. They were "Dyslexia is related to a lack of parents' supervision", "Dyslexia is related to a lack of motivation for learning" and "Dyslexia will usually improve when student grows up". The answers of all these questions were "false". This was expected as teachers were more informed about such situations. They usually had regular contact with parents for discussing students' academic performance. They were probably aware that no strong correlation existed between parents' supervision and the occurrence of dyslexia. In other words, dyslexia did occur irrespective of whether parent supervision was adequate or not. Similarly, teachers could readily notice that dyslexia occurred and did not improve though there were children who were eager to learn. As for Question "Medication is effective for dyslexia", over 90% of the teachers in that study but only 74.4% of the nursing students in the present study answered the question correctly (realising the statement was false). Nursing students were expected to be more familiar than teachers with drug therapy but surprisingly over a quarter of them had the misconceived notion that medication was

Department of Health, 2006).

effective in the treatment for dyslexia. Considerable lower percentage of respondents in both studies gave correct answers to other two questions, namely, "Hyperactive students will have various degree of dyslexia" and "All dyslexic students suffer problem of inattention". The correct answers for both should be "false". The possible explanation for the misconception is likely to be the common occurrence of attention-deficit/hyperactivity disorder (ADHD) and dyslexia and the relationship between the two disorders being mistakenly perceived to be causal instead of comorbid. The comorbidity of ADHD and dyslexia is well recognised. A meta-analysis study indicates that pharmacological interventions (mainly the use of stimulants) are more effective than non-pharmacological interventions in treating ADHD but still not significant in improving academic performance. As ADHD is wrongly perceived to be the cause of dyslexia and medication is found to be effective for ADHD, one may conclude that medication will thus be effective for dyslexia. The possible reason of better performance of teachers in this question is that they may misunderstand that the medication prescribed is used for the co-existing ADHD problems. Hence, when the teachers notice that dyslexic problems cannot be improved by the medication, they may well believe that the medication is ineffective for dyslexia.
