DYSLEXIA
Published online 8 October 2014 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/dys.1484
■ The Inclusion of Students with Dyslexia
in Higher Education: A Systematic Review
Using Narrative Synthesis
Marco Pino1* and Luigina Mortari2
1
University of Nottingham, UK
University of Verona, Italy
2
This article reports on a study focusing on the inclusion of students with dyslexia in higher
education (HE). A systematic review was carried out to retrieve, critically appraise and synthesize the available evidence on how the inclusion of students with dyslexia can be fostered in HE.
The 15 studies included in the final synthesis employed descriptive designs and overwhelmingly
used qualitative methods to explore dyslexic students’ perceptions on the impact of teaching,
support and accommodation in their own learning experience. A critical appraisal of these studies revealed a landscape of significant gaps in the available stock of evidence on the inclusion of
students with dyslexia in HE. The synthesis of the available evidence is presented in a narrative
of five cross-study thematic areas: student coping strategies, being identified as dyslexic, interaction with academic staff, accessibility and accommodations, and using assistive technologies and
information and communication technologies. Implications for practice and future research are
discussed. ©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
Keywords: dyslexia; inclusion; higher education; systematic review
INTRODUCTION
Internationally, the number of students with disabilities enrolled in higher education institutions (HEIs) is on the rise, with the most commonly reported disability
being specific learning difficulties (SpLDs), including dyslexia, dyscalculia and
dyspraxia. In the UK, an estimated 4% of students enrolled at all higher educational
levels (including undergraduate and postgraduate) had SpLDs in the 2011–2012 academic school year (Higher Education Statistics Agency [HESA], nd). In the USA,
students with disabilities represented nearly an estimated 11% of all postsecondary
students in 2008, of whom less than 10% had SpLDs according to the National
Postsecondary Student Aid Study (although two longitudinal studies reviewed by
the Government Accountability Office estimated that students with SpLDs constituted 70% of the population of disabled students in HEIs; Government
Accountability Office [GAO], 2009).
*Correspondence to: Marco Pino, Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life
Care, School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2HA,
UK. E-mail: marco.pino75@gmail.com
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs
License, which permits use and distribution in any medium, provided the original work is properly cited, the use is
non-commercial and no modifications or adaptations are made.
The Inclusion of Students with Dyslexia in HE
347
It can be argued that the increase of provisions and support has made it more
affordable and attractive for students with disabilities to pursue postsecondary
education. Internationally, legislative changes have been introduced to prevent
discrimination and to provide equality of access to higher education (HE). For
instance, the UK’s Disability Discrimination Act of 1995 established disabled people’s right to participate fully in the educational process and imposed an obligation
on HEIs to provide equality of access to education through removing barriers and
implementing academic adjustments and auxiliary aids and services (Kirkland,
2009). In the USA, HEIs are required to implement reasonable adjustments that
would not fundamentally alter the nature of the instruction, lower academic requirements or result in undue financial or administrative burdens (GAO, 2009).
Higher Education Students with Dyslexia
HE students with dyslexia often experience problems with information processing,
note-taking, essay writing and organization (British Dyslexia Association [BDA],
2013). A lack of confidence can affect their performance, especially in social
situations, such as reading and writing in front of others. Dyslexic students pose
a particular challenge to academic staff because their difficulties are hidden (Riddell
& Weedon, 2006). The possibility of meeting the needs of students with dyslexia
and enhancing their learning potential is, therefore, contingent upon their choice
to self-identify as having a diagnosis of dyslexia. Frequent adjustments for HE
students with dyslexia include note-takers, dictaphones, spellcheckers and extra
time or support for assessments and exams.
Research is needed to determine whether these strategies can be effective in
creating more equal opportunities for students with dyslexia to participate in
HE. No attempts have been made, to our knowledge, to systematically review
the available evidence on the impact of strategies and practices designed to foster
the inclusion of students with dyslexia in HE. Through this study, we aim to fill this
gap by systematically reviewing empirical research that explored the impact of
adjustments and support on the inclusion of students with dyslexia in HE. After
accounting for how the bibliographic search and appraisal of existing studies was
carried out, the report focuses on the area that has received the most attention
by the research community, that is, how students with dyslexia themselves experience participation, learning, adjustment and support in HE. Through a narrative
synthesis of the literature that seeks to give voice to students with dyslexia, this
review provides an updated picture on how issues of inclusion and participation
in HE are perceived by students themselves, and produces recommendations for
practice and future research.
METHOD
A systematic review was undertaken. This research method allows one to retrieve, critically appraise, summarize and reconcile the available evidence regarding
a specific problem and to inform policy and practice (Petticrew & Roberts, 2006).
A systematic review aims to comprehensively identify all relevant studies to
answer a particular question and assesses the validity of each included study and
taking it into account when making conclusions. The research question that
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
348
M. Pino and L. Mortari
initially informed this review was as follows: How can the inclusion of students with
dyslexia be fostered in mainstream educational settings from primary schools to HE?
Another requirement for a systematic review is the transparent accounting of the
procedures for the identification, selection, appraisal and analysis of the literature
to be included in the final synthesis. These steps are described in the following section.
Identification of the Relevant Literature
A systematic literature search was performed in the following electronic databases: ERIC, PsycCRITIQUES, PsycInfo, Scopus, ISI Web of Science, ASSIA, International Bibliography of the Social Sciences, Proquest Dissertations & Theses,
ProQuest Education Journals, ProQuest Career and Technical Education,
Academic Search Premier and Medline. The search strategy was an adaptation of
the strategy employed in a systematic review of the inclusion of students with special educational needs in mainstream classrooms carried out by the EPPI centre
(based in the University of London and specialized in systematic reviews in the educational sector; Nind et al., 2004). Unlike that review, the search for this study
was limited to students with dyslexia. Table 1 describes the search strategy
employed in ERIC, which was adapted to fit the other databases. The search was
designed to systematically retrieve English-language studies focusing on the
inclusion of students identified as dyslexic in mainstream educational institutions,
ranging from primary to HE educational levels, and published between 1994 (when
the Salamanca agreement (UNESCO, 1994) marked the global commitment to inclusion) and October 2013. No methodological delimiters (e.g., only outcome
evaluations) were employed. Attempts were also made to retrieve unpublished
reports (so called ‘grey literature’, including theses and dissertations, internal reports and conference communications, whenever available). Relevant websites
and journals were also manually searched, as were the reference lists from the retrieved studies (so called chaining technique). Furthermore, e-mails were sent to
several researchers and organizations that were active in the area of dyslexia.
All citations were saved using a reference management software to remove duplicates and to keep record of the selection process.
Selection of Studies
Studies were included that met the following inclusion criteria: (1) were conducted in mainstream educational settings; (2) focused on students identified as
dyslexic; (3) contained indications of the impact of interventions, supports and
services on students; (4) were concerned with educational levels ranging from
primary school to HE; (5) involved empirical studies such as descriptions,
Table 1. Search strategy
Primary search in ERIC (1994–October 2013, English language)
YR(1994 OR 1995 OR 1996 OR 1997 OR 1998 OR 1999 OR 2000 OR 2001 OR 2002 OR 2003
OR 2004 OR 2005 OR 2006 OR 2007 OR 2008 OR 2009 OR 2010 OR 2011 OR 2012 OR 2013)
AND SU(dyslex*) AND SU(inclusion OR inclusive education OR inclusive schools OR
mainstream* OR regular and special education relationship OR universal design for learning)
NOT LV(Early Childhood Education AND Preschool Education)
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
The Inclusion of Students with Dyslexia in HE
349
explorations of relationships, evaluations and systematic reviews; and (6) were
published or produced between 1994 and October 2013.
The primary studies identified were inconsistent in defining dyslexia and inclusion, reflecting a general lack of consensus regarding the meaning of these terms
(Norwich, 2009). Some authors conceptualized dyslexia as a “disorder in which
a persistent problem arises with acquiring and applying reading and/or spelling at
word level” (Diraä, Engelen, Ghesquière, & Neyens, 2009, p. 457), while others
viewed it as a form of neurodiversity, that is, “as a normal human difference that
should be tolerated and respected in the same way as other human differences”
(Griffin & Pollak, 2009, p. 25). The ERIC Thesaurus defines dyslexia as “impairment
in the ability to read despite adequate intelligence and proper instruction” (Education Resources Information Center [ERIC], nd). This systematic review includes
studies focusing on students who were identified as dyslexic (BDA, 2013). As
for the term ‘inclusion’, the ERIC Thesaurus defines it as “successfully educating
all students (whether with or without disabilities, disadvantages, etc.) together in
the same schools and classrooms, while celebrating the resulting diversity, including various abilities and cultures” (ERIC, nd). In line with this definition, this systematic review includes studies that addressed interventions, services and other
forms of support that were designed to enable dyslexic students’ access to the
mainstream curriculum and to help improve their learning experience therein.
Figure 1 displays the screening process using a PRISMA flowchart (Moher et al.,
2009). The studies retrieved through the primary search strategy (electronic databases) underwent a two-stage process. First, they were screened based on inspection of titles and abstracts. Next, the included studies went through a second-stage
screening that consisted of full-text inspection. Ultimately, the overall screening
process identified 50 studies that met our criteria. Of these, 15 focused on HEIs
and are examined exclusively in this report.
Figure 1. PRISMA flowchart.
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
350
M. Pino and L. Mortari
A decision was made to retain studies focusing on students enrolled in access
courses in preparation for taking a degree course because these studies also involved dyslexic students who were engaging in postsecondary education and were
of the same age group as the participants in the other studies. Furthermore, many
themes described in these studies resonate with the ones emerging from the studies carried out in the HEIs. Finally, we also decided to include studies that focused
on students with different types of disabilities, extracting relevant data for our review, provided that it was possible to discriminate study findings that specifically
referred to students with dyslexia.
Critical Appraisal and Data Extraction
A systematic review should not blindly incorporate all the available evidence regardless of the trustworthiness of the primary studies. We therefore performed
a critical appraisal by adapting procedures devised by the EPPI centre (Nind
et al., 2004; Oliver & Peersman, 2001). The selection process returned 15 studies
that incorporated descriptive designs, whose main area of thematic overlap was
dyslexic students’ own perceptions on learning, participation, adjustment and support in HE. Hence, for the in-depth phase of the review (including critical appraisal,
extraction, analysis and synthesis of evidence from the primary studies), we
narrowed our focus to the following question: How do students with dyslexia experience the impact of teaching, adjustment and support in HE?
Because the 15 studies that remained after screening overwhelmingly used
qualitative research methods, we also followed the indications of the Cochrane
Collaboration Qualitative and Implementation Methods Group (Hannes, 2011)
and the Centre for Evidence-Based Management (CEBMa, nd) to ascertain the
quality of the studies along four dimensions (Lincoln & Guba, 1985): credibility
(findings fit the perceptions of the participants), transferability (findings can be useful to illuminate other settings), dependability (the research process is traceable
and clearly documented) and confirmability (the effect of the researcher(s) is
accounted for). Such dimensions bear on the soundness or trustworthiness of
the studies, that is, on their ability to answer their own research questions. Our
appraisal tool (reproduced in the APPENDIX) comprises 10 yes–no questions divided into two domains: internal methodological coherence and relevance of the
study focus for the review questions. For the assessment of internal methodological coherence, we asked whether each study focused on a clearly defined question, the appropriateness of the research method, sample design and analysis
procedures for answering such question, and whether participants and setting
were clearly described. We also checked the reliability of the analysis procedure
and the traceability of the research process. For the assessment of relevance,
we asked whether each study dealt with aspects that were relevant to the inclusion of dyslexic students in HE (e.g., teaching approaches, assessment approaches,
support services, identification/diagnosis of dyslexia in HEIs, use of assistive technologies [ATs] and information and communication technologies [ICTs], peer support, and relationship and communication with academic staff) and whether each
study provided extensive and detailed representations of the students’ views on
these matters. The overall weight of evidence assigned resulted from synthesizing
these separate judgments (internal soundness and relevance to the review question) and rating each study along a 5-points scale: low, medium-low, medium,
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
The Inclusion of Students with Dyslexia in HE
351
medium-high and high weight of evidence (see the appraisal tool in the
APPENDIX). We decided to include in the final synthesis all the studies that had
scored above low. The rationale behind this inclusive approach was that the goal
of this review was to provide an initial overview of the existing knowledge state
regarding the inclusion of people with dyslexia within HE, a relatively new and
unexplored domain, and to stimulate further research on the topic. Nevertheless,
not all of the results reported in the primary studies were included in the final
synthesis. The differences in weight of evidence among the primary studies were
also taken into account in the synthesis stage so that studies with a high or
medium-high weight of evidence influenced the review results and conclusions
more than the other studies. In addition to these inter-study comparisons, an
intra-study comparison was undertaken to discriminate data that, in each primary
study, could be considered as having primary weight for this review. For instance, a
primary study could report findings (e.g., how students with dyslexia experience
assessment in HE) that were strongly supported through extensive quotes while also
containing findings that were less convincingly demonstrated. As a result, all findings
evaluated as having primary weight of evidence were given priority in the review
synthesis. Findings that gained a secondary weight of evidence were considered as
indicative but not determinant in the formation of the synthesis.
Two options are generally available for data extraction (Noyes & Lewin, 2011a):
selective and inclusive. Because the question raised in this review is relatively
new and unexplored and to avoid missing potentially valuable evidence to the review question, we adopted an inclusive approach to data extraction. All text
contained in the results sections of the primary studies (including data and author
interpretations) that was relevant to the review question was thus copied to an
extraction sheet.
Analysis and Synthesis of Evidence
The text extracted from the primary studies constituted the data for the in-depth
review and was analysed using thematic analysis (Braun & Clarke, 2006; Noyes &
Lewin, 2011b) to identify recurring themes. The analyses were conducted using
the following steps: (i) repeated reading; (ii) identification of relevant units of
meaning (conceived as discrete portions of text where a participant’s view is conveyed regarding a single matter relevant to the review question; Braun & Clarke,
2006); (iii) labelling of each unit using a descriptive code; (iv) grouping of the codes
into themes; and (v) grouping of the themes into thematic areas. The analysis was inductive and iterative by repeatedly returning to the data to check the ability of the
emergent themes to fit the students’ perceptions as displayed in the primary studies.
Finally, emergent themes that were only supported by secondary weights of evidence were dropped from the final synthesis. The remaining themes are supported
by data having primary weights of evidence. The thematic areas are displayed in
Figure 2, which also shows the set of primary studies supporting each thematic area.
Two main approaches are available for synthesizing such evidence as ours
(Barnett-Page & Thomas, 2009; Dixon-Woods et al., 2004; Noyes & Lewin,
2011b; Parry & Land, 2013): integrative (sometimes called aggregative) and interpretive (also known as theory building). We employed an integrative approach
by identifying recurrent themes across the primary studies and summarizing them
under thematic headings. Our primary goal was not to engage in secondary data
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
352
M. Pino and L. Mortari
Figure 2. Thematic areas. ATs, assistive technologies; ICTs, information and communication technologies; HE, higher education.
analysis and independent theory generation, but to bring together the available evidence on how dyslexic students experience the impact of teaching, adjustment and
support in HE. This required a certain amount of cross-study translation in order to
reconcile themes that took different names in different studies. Nevertheless, we
did not identify themes that had not been already identified in the primary studies.
The methodological homogeneity among the primary studies, which were
overwhelmingly interview-based qualitative studies, facilitated this endeavour.
Consistent with the integrative approach to synthesizing evidence is the use of
thematic analysis for analysing the extracted data and of narrative synthesis for
reporting findings (Dixon-Woods et al., 2004). Narrative synthesis involved
descriptively summarizing the identified themes under thematic headings.
RESULTS
Our bibliographic search identified 15 relevant studies. The results of the critical
appraisal are displayed in Table 2, which also includes an overview of each study
(in what follows, we refer to the primary studies through the study label numbers
in Table 2; notice that study N.13 was reported in two separate publications).
Six studies (3; 9; 12; 13; 14; 15) were considered to have a low level of internal
methodological coherence because the data collection or the analysis procedures
were not clearly traceable. Six studies were granted a medium level of internal
methodological coherence because the authors’ interpretations were not always
supported through participants’ quotes (1; 2; 7; 8) or the study failed to provide
detailed information on the students’ perceptions of an intervention (4) or some
of the analytic procedures were not described (6). Three studies (5; 10; 11)
presented a high level of methodological coherence due to the transparency and
solidity of their research designs, and their ability to provide in-depth characterization of the students’ views. With regards relevance for the review question,
one study (4) presented low relevance because only one dyslexic student had been
informally interviewed. Four studies had medium relevance because they did not
always discriminate between the views of dyslexic students and those of other
participants (2; 7), or the findings were primarily based on the perspectives of
other types of participant and only secondarily on those of dyslexic students (8),
or the study design allowed only limited exploration of the students’ experiences
(6). The remaining studies (1; 3; 5; 9; 10; 11; 12; 13; 14; 15) were highly relevant
for the review question.
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
Diraä,
Engelen,
Ghesquière
& Neyens
CornettDeVito
2
3
Carter &
Sellman
Author(s)
1
Study #
Constructivist
Grounded
Theory
Methodology
Method of
data gathering
Method of
data analysis
Weight of evidence (WoE)
and main elements bearing
on critical appraisal
Description,
reduction and
interpretation
(iterative
process).
Meaningfulness of
themes confirmed
through a focus
group
Semi-structured Unspecified
interviews
In-depth
interviews
Internal soundness: low
(data analysis not
described; aspects of
intervention delivery left
unspecified).
Relevance for the review
question: high.
WoE: medium
Internal soundness:
medium (interpretations
not always supported
through quotes).
Relevance for the review
question: medium (it is
unspecified how many
participants were
dyslexic).
WoE: medium
11 students
Semi-structured Coding and
Internal soundness:
(4 with dyslexia) interviews
categorizing using medium (interpretations
NVivo
not always supported
through quotes).
Relevance for the review
question: high.
WoE: medium-high
Sample
2005/USA Phenomenology 21 students
with learning
difficulties
(LDs) (number
of students
with dyslexia
unspecified; the
results section
reports the
views of 3
students with
dyslexia)
2009/
Survey
32 students
Belgium
with dyslexia
2013/UK
Year/
country
Table 2. Description of studies (N = 15)
(Continues)
Difficulties in assistive
technology (AT) use
were related to software
configuration and
disclosure of dyslexia.
Students’ use of AT was
limited to low order
functions.
Concordance between
one’s own way of
working and contextual
expectations is
important to account
for differences between
students’ experiences
of writing.
In the view of students,
competent instructors
provide individualized
instruction, build
rapport, demonstrate
knowledge about LDs,
are alert to alternatives
to assist student
learning, and are
accessible outside the
classroom.
Main results
The Inclusion of Students with Dyslexia in HE
353
DYSLEXIA 20: 346–369 (2014)
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
Farmer,
Riddick &
Sterling
Dziorny
5
6
Dixon
Author(s)
4
Study #
Table 2. (Continued)
Mixed methods
Methodology
2002/UK
Survey
2012/USA Mixed methods
2004/UK
Year/
country
Questionnaire,
participant
observation,
video recording
of students using
the software and
informal
interviews
74 students
with dyslexia
Questionnaire
Online survey: Online survey,
92 students
observations
and two semistructured
interviews
Observation
and interviews:
8 students
(3 with
dyslexia)
25 students
(2 disclosed
dyslexia)
Sample
Method of
data gathering
Descriptive
statistics;
procedure for
qualitative analysis
unspecified
Descriptive
statistics;
Grounded
Theory
Descriptive
statistics;
qualitative data
analysis of video
recordings
Method of
data analysis
Internal soundness:
medium (procedures of
qualitative analysis left
unspecified).
Relevance for the review
question: medium (the
Relevance for the review
question: high.
WoE: high
Internal soundness:
medium (no details on
how the software
improved students’
understandings).
Relevance for the review
question: low (only one
dyslexic student informally
interviewed).
WoE: medium-low
Internal soundness: high
(interpretations grounded
in quotes; traceable
research process).
Weight of evidence (WoE)
and main elements bearing
on critical appraisal
(Continues)
The animation software
tool moderately
increased the students’
learning. The dyslexic
students valued the
following components:
explicit visual model,
one-to-one support,
repetition and
formative feedback.
The students enrolled
in an online course
using Second Life
reported both technical
difficulties and benefits
(including learning
through concise and
multiple-format
materials). The study
describes students’
difficulties, coping
strategies and views of
support in HE.
The study describes the
experience of being
identified as dyslexic.
Main results
354
M. Pino and L. Mortari
DYSLEXIA 20: 346–369 (2014)
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
Hanafin,
Shevlin,
Kenny &
Mc Neela
Hadjikakou
& Hartas
8
9
Griffin &
Pollak
Author(s)
7
Study #
Table 2. (Continued)
2007/
Ireland
2008/
Cyprus
2009/UK
Year/
country
Unspecified
(qualitative)
Unspecified
(qualitative)
Unspecified
(qualitative)
Methodology
Semi-structured Thematic analysis
interview
using both NVivo
7 and a traditional
paper-based
approach;
constant
reviewing of
emergent themes
Method of
data analysis
16 students
(7 with
dyslexia)
Semi-structured Textual readings
interview
of transcripts and
identification of
categories
10 students
Semi-structured Thematic analysis
with disabilities interviews and
(2 with
focus groups
dyslexia), 4
tutors and 10
Heads
27 students
with LDs
(13 with
dyslexia)
Sample
Method of
data gathering
study design provides only
limited access to
students’ views).
WoE: medium
Internal soundness:
medium (interpretations
not always supported
through quotes).
Relevance for the review
question: medium
(responses from students
with different LDs are not
always differentiated).
WoE: medium
Internal soundness:
medium (interpretations
not always supported
through quotes).
Relevance for the review
question: medium (findings
primarily based on tutors’
views and only secondarily
on students’ views).
WoE: medium
Internal soundness: low
(research process not clearly
traceable and only limited
space granted to students’
views through quotes).
Weight of evidence (WoE)
and main elements bearing
on critical appraisal
(Continues)
Students described
accessibility issues and
lecturers’ lack of
awareness of dyslexia.
The study describes the
emotional and identity
implications of being
formally identified as
neurologically diverse
individuals. Students
reported difficulties with
lecturers and
accessibility issues with
HE courses.
Students described
lecturers’ lack of
awareness of dyslexia.
Main results
The Inclusion of Students with Dyslexia in HE
355
DYSLEXIA 20: 346–369 (2014)
Hughes,
Herrington,
McDonald
& Rhodes
PalfremanKay
Pollak
11
12
Author(s)
10
Study #
Table 2. (Continued)
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
2005/UK
2000/UK
2011/UK
Year/
country
Unspecified
(qualitative)
Grounded
theory
Ethnography
Methodology
Method of
data analysis
Weight of evidence (WoE)
and main elements bearing
on critical appraisal
Relevance for the review
question: high.
WoE: medium
2 students with Interviews
Construction of a Internal soundness: high
dyslexia and
retrospective
(interpretations grounded
1 tutor
narrative;
in quotes; coherent and
collaborative
highly traceable research
analysis in which process).
the participants
Relevance for the review
are coquestion: high.
researchers;
WoE: high
reflexivity
8 students with Semi-structured In vivo coding,
Internal soundness: high
dyslexia
interviews
identification of
(interpretations grounded
themes,
in quotes; coherent and
reflexivity
highly traceable research
process).
Relevance for the review
question: high.
WoE: high
33 students
Interviews
Coding of
Internal soundness: low
with dyslexia
transcripts using (research process not
NUD.IST;
clearly traceable;
member checks interpretations not clearly
grounded in quotes).
Relevance for the review
question: high.
WoE: medium
Sample
Method of
data gathering
(Continues)
The study describes
how the students came
to terms with a formal
diagnosis of dyslexia.
The findings cover
students’ views of peer
support, professional
support, ATs and
identification as
dyslexic.
The e-portfolio tool
(based on the system
PebblePad) enabled the
students to gain control
of the medium and,
hence, of their own
learning process.
Main results
356
M. Pino and L. Mortari
DYSLEXIA 20: 346–369 (2014)
Taylor &
PalfremanKay
15
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
2000/UK
1997/UK
2006/UK
13b) Riddell
& Weedon
Riddick,
Farmer
& Sterling
2005/UK
Author(s)
Year/
country
13a) Riddell,
Tinklin &
Wilson
14
13
Study #
Table 2. (Continued)
Methodology
Critical
ethnography
and Grounded
Theory
Unspecified
Case study
Sample
10 students
with dyslexia
and 4 deaf
students
16 students
with dyslexia
48 students
with dyslexia
Unspecified
Unspecified
Method of
data analysis
Internal soundness: low
(no data analysis is
provided by the authors).
Relevance for the review
question: high.
WoE: medium
Internal soundness: low
(data collection and
analysis procedures not
traceable).
Relevance for the review
question: high.
WoE: medium
Weight of evidence (WoE)
and main elements bearing
on critical appraisal
Semi-structured Grounded theory Internal soundness: low
interviews
(data collection and
analysis not clearly
traceable).
Relevance for the review
question: high.
WoE: medium
Interviews
In-depth
interviews
Method of
data gathering
Main results
The study describes (1)
students’ experiences
with being identified as
dyslexic and (2) their
views on the meaning
of disability and access
to reasonable
adjustment in
assessment.
The study presents
students’ narratives
about being identified as
dyslexic, coming to
terms with the label of
dyslexic, attitudes of
relevant others and
institutional support.
Students with dyslexia
received more support
by non-disabled peers
than deaf students did.
The Inclusion of Students with Dyslexia in HE
357
DYSLEXIA 20: 346–369 (2014)
358
M. Pino and L. Mortari
Three studies (5; 10; 11) earned an overall high weight of evidence (having scored
high both in internal methodological coherence and relevance for the review
question). The remaining studies scored between medium-high and medium-low.
Because no study scored low, we included all the studies in the final synthesis.
Overall, the critical appraisal and mapping of the relevant literature yielded a
picture characterized by a limited amount of high-quality evidence (we will discuss
some of the gaps in the available evidence throughout the analysis). Nevertheless,
our inclusive approach to data extraction (see Critical Appraisal and Data Extraction section) allowed the retrieval and synthesis of a significant amount of evidence, with considerable areas of thematic convergence across the studies.
These thematic areas include student coping strategies (8 studies), being identified
as dyslexic (6 studies), interaction with academic staff (10 studies), accessibility and
adjustments (12 studies), and using ATs and ICTs (8 studies) (Figure 2). In what
follows, we present the thematic areas in a narrative synthesis of how students
experienced the impact of teaching, adjustments and support throughout their
learning journey in HE. We use quotes from the primary studies to exemplify
some of the themes.
Student Coping Strategies
Eight studies (1; 5; 6; 7; 10; 12; 14; 15) dealt with how students with dyslexia overcome or compensate for difficulties in the HE environment; four themes were
identified: study skills; compensatory strategies; help from family, friends and fellow students; and meta-cognitive and meta-affective skills.
Study skills that the students employed included strategies to deal with written
texts, such as reading slowly and out loud (5), identifying key points (1), and
underlining or copying sentences from books (14). Some students positively valued the opportunity to access materials in multiple formats (visual and oral; 5)
and to study using visual techniques (concept maps and colour coding, which are
helpful for memory; 7; 10; 12) and oral techniques (talking about study contents
with others rather than writing down notes; 14). One study (1) described how
some students navigated writing requirements both by adapting their style to meet
academic standards and by negotiating the potential modification of some of those
standards; for them, using a clear and straightforward writing style was helpful, and
they reported that sometimes the use of informal expressions was accepted
(‘Student F confidently uses informal expressions (don’t, it’s, and dodgy ground),
explaining that not only does this “suit him”, but that it is acceptable in his department, where explaining complex ideas independently and simply is valued’; 1, p. 160).
Compensatory strategies were used by students in the context of lectures and
include receiving copies of notes and transparencies from professors (5),
downloading and printing PowerPoint presentations before lectures (writing notes
on the printed copies spared the students from moving their gaze back and forth
between the screen and the notebook; 5) and tape-recording lectures (5; 6; 7).
Many students relied on help from family members, friends and fellow students in
several aspects of their work, such as writing (revising and editing drafts; having
someone type for the student; 5), and obtaining or integrating notes (borrowing
lecture notes from other students; 5; 14; 15).
Many students described meta-cognitive and meta-affective skills. Meta-cognitive
skills include self-organization strategies such as time planning (6; 7) and using
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
The Inclusion of Students with Dyslexia in HE
359
essay-plan diagrams (12). Some students selected the most productive times and
places to study to maximize one’s own ability to learn (1; 12). The latter set of
strategies also has meta-affective relevance, insofar as it helped to reduce
distractions and create a ‘comfort zone’ (Carter & Sellman, 2013) in which
feelings of competence are generated. These strategies reveal students’
knowledge of their own abilities, weaknesses and preferred learning styles.
Additionally, they signal students’ understanding of their own emotional
responses and their ability to manufacture environments that minimize negative
effects. Some students displayed awareness of the fact that their level of interest
in the subject matter at hand could significantly influence their opportunities to
succeed (5); that is, enthusiasm could compensate for earlier negative school
experiences, which could otherwise prevent dyslexic students from productively
interacting with the learning environment (1). Another learning strategy to which
several students recurred was repetition (e.g., interacting with materials at
length) (5; 12).
Being Identified as Dyslexic
Six of the reviewed studies (6; 7; 11; 12; 13; 14) focused on the students’ experiences of being identified as dyslexic while being enrolled in HE. Several students
reported that assessment procedures could cause stress and anxiety (e.g., about
performance; 6; 11; 12). The first diagnosis of dyslexia could produce an initial
shock or disorientation (6; 11; 12), making it hard to accept (‘I felt quite down
about it and I actually took my time in accepting that I was dyslexic’, 11,
p. 211). Coming to terms with the label of ‘dyslexic’ can be difficult, and some
students reported that they did not regret not having been diagnosed earlier
(e.g., ‘I’m quite pleased I hadn’t known until I was 15, because if I’d known earlier
it might have been an excuse, or there would have been a reason for not doing
your GCSEs’, 14, p. 134; 13). While some students described themselves as disabled, others came to terms with the ‘dyslexic’ label by considering themselves as
having ‘difficulties’; for them, this definition was more compatible with the selfimage of competent individuals (‘[I] don’t see myself as disabled. I ask myself
the question, “Has it stopped me from doing anything?” and the answer is
“No” ’, 13a, p. 137).
For the majority of students surveyed, though, the diagnosis ultimately had a
positive impact. First, this diagnosis brought a sense of relief because the assessment confirmed that one was not simply ‘stupid’—a perception often acquired
through early school experiences (‘At least I know it’s not me being stupid, me
being disorganised’, 14, p. 97; also 6; 7; 11; 12; 13). The diagnosis, then, provided
an explanation for the difficulties encountered by the students (14). Secondly, and
related to this, the diagnosis opened the door to the possibility of building a more
realistic view of one’s own strengths and weaknesses (11), with the possible effect
of bolstering self-esteem (13), increasing confidence (14) and fostering encouragement to carry on with one’s own studies (14).
Interaction with Academic Staff
Ten studies dealt with students’ experiences with academic staff (2; 5; 7; 8; 9; 10;
11; 12; 13; 14). The most critical aspect raised by the students was the lack of
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
360
M. Pino and L. Mortari
awareness of dyslexia on the part of some lecturers and tutors (13; 14). Some
teachers in HE were unresponsive when students communicated their dyslexia
(‘Some tutors have been really good and asked me to tell them that I’m dyslexic
as they really need to know and others have sort of said, “Oh well so what, what
do you want me to do about it?” ’, 13b, p. 67). Some even displayed misconceptions or prejudice towards dyslexic people, for example by confusing dyslexia with
mental retardation (8), mistaking it for laziness (13), considering it as an ‘excuse’ to
obtain concessions (13; 14), or viewing dyslexic students as unable to succeed
academically (‘When I, I went to see a lecturer about my essay he told me that
there was no point aiming for any higher because you’re dyslexic’, 7, p. 34; 9;
11) or in specific professions such as medicine (13). Some teachers expressed
scepticism about the very existence of dyslexia (7). Some consequences of these
teachers’ attitudes were that students had to struggle to obtain teachers’ attention
and insist on obtaining modifications (9; 13; 14). In addition, some teachers failed
to take dyslexia into consideration when grading students’ work (e.g., some students received lower marks for bad spelling; 14). Some academic staff members
were also reported to have expressed concerns about equality (13; 14). For instance, some teachers withheld the provision of lecture notes in electronic format,
claiming that this would give unfair advantage to the students with dyslexia over
other students (2; 3). Conversely, the students appreciated teachers who demonstrated knowledge and awareness of dyslexia (2; 7; 8; 9; 11; 12). Responsiveness
and readiness to provide resources and adjustments (10; 11; 12; 14), availability
(2; 7) and willingness to answer questions (5) were positively valued qualities. In
some specific settings (such as the blended course described in 10), rapport was
seen as an integral part of the learning process (see also 7; 11). Valued tutor qualities included empathy (10; 12), sympathy (2; 13), trustworthiness (11) and openmindedness (10; 11). Congruence between tutor values and student values was
also important (10).
Teaching approaches
Students valued teaching approaches that took into account learners’ differences.
A student contrasted this approach to one in which students are ‘told do this, get
on with it’ (10, p. 59). In two studies (5; 12), students made positive comments
about interactive teaching styles, in which their contribution in discussing course
content was welcomed. These students described themselves as willing to engage
actively in the learning process and to interact with course materials and other
students when given the opportunity to do so (5). Practice and hands-on
experience were also valued significantly compared with more traditional
pedagogical formats (e.g., straight lectures). A student-centred style was
described in one study (10); this was regarded as a non-judgemental, appreciative
style that acknowledged students’ background knowledge and gave them
responsibility. This outlook is compatible with overcoming the deficit model of
dyslexia and adopting a more nuanced, multi-layered view of this condition,
taking into account not merely students’ weaknesses but also their strengths
(e.g., creative and critical thinking). A student-centred approach was also
regarded as empowering, insofar as it enabled the students to speak in their
own voice and to use their own language. Graphic-rich presentation styles, formative feedback and making the lecture structure explicit at the outset were also
regarded as useful (12).
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
The Inclusion of Students with Dyslexia in HE
361
Universal design for learning
It has been argued that many obstacles to the inclusion of dyslexic students can be
prevented by adopting a universal design for learning (UDL; Dziorny, 2012); that
is, designing education to simultaneously accommodate students with diverse
learning needs, including students with disabilities and SpLDs. In this framework,
instruction is designed with an orientation towards the diversity among student
needs. This reverses the traditional instructional approach in which adjustments
for diverse students must be negotiated on an individual basis. In UDL, an orientation to the needs of all students is incorporated in the instructional design from
the outset. This review identified three studies (4; 5; 10) that explored students’
experiences of instructional interventions that were designed to simultaneously
accommodate the needs of students with and without SpLDs. All interventions
used ICTs. For instance, Dixon (2004) showed that a Code-Memory Diagram
Animation Software Tool enhanced students’ self-reported understanding in a computer programming module. According to Dixon, the software helped foster learning for all students but dyslexic students especially. However, the critical appraisal
raised concerns about the ability of this study to describe in detail how the software
improved students’ understandings. The study thus had limited relevance in the context of the present review, whose goal was to elucidate students’ own understandings of what enhances their instructional experience. Another limitation of Dixon
(2004) is that only one dyslexic student was informally interviewed in this study.
Hughes, Herrington, McDonald, and Rhodes (2011) studied the implementation of
an e-portfolio-based course delivered to students with and without dyslexia. After
describing how, in the view of two students with dyslexia, the e-portfolio enabled
the personalization of their learning processes, the authors suggested that the course
was also beneficial to students without dyslexia; however, this finding was derived indirectly from the reports of the two learners with dyslexia who took part in the
study. Finally, Dziorny (2012) studied the impact of an online instructional design
using Second Life on the learning experience of students with and without dyslexia.
Nevertheless, when drawing conclusions from the data, Dziorny focused exclusively
on whether the course met the needs of the students with dyslexia. These studies
show how it is possible to design inclusive courses to meet the learning needs of students with and without dyslexia. More research is needed, however, to compare
how dyslexic and non-dyslexic students experience working together and utilizing
the same learning tools and materials.
Written exams
Written exams as described in the reviewed studies were associated with several
difficulties, such as having insufficient time (12; 13; 14) and lacking adequate
prompts to help recollect relevant information (14). Moreover, emotional tension
and stress could be associated with declining performance in spelling and grammar
(12) and with forgetting otherwise known information (14). Some students felt
discriminated by the use of written examinations as the dominant assessment
modality because their writing performance did not reflect their actual level of
knowledge and mastery of the subject matters (12; 13). Extra test-taking time
was hardly sufficient to compensate for this state of affairs, which can be overcome
by introducing alternative assessment modalities (‘Rather than extra time in
exams, Maurice considered that an alternative form of assessment based on oral
work should be permitted’, 13a, p. 135).
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
362
M. Pino and L. Mortari
Lectures
As for lectures, many students found it useful to receive printed handouts (with
appropriate font type and size) (7; 12), to download electronic presentations
and notes and to read them in advance (3; 7). These resources can help compensate
for the difficulties associated with having to coordinate note-taking and listening to
teachers in real time, especially when they talk fast. Some students lamented
excessive reading requirements in the context of online courses (5).
Accessibility and Adjustments
Twelve studies dealt with issues of accessibility and adjustments (1; 2; 3; 5; 6; 7; 8;
11; 12; 13; 14; 15). Modifications of examination protocol included additional
time, note-takers, use of laptops, providing alternative testing environments,
and expanding or substituting written with oral examination. While assessing
students’ work, teachers could take into consideration their dyslexia and, hence,
make allowances for incorrect spelling and grammar. In addition, extended deadlines
were often provided to complete course assignments, such as essay writing. Useful
adjustments to lectures included the following: allowing the recording of lectures,
adjusting the speed of information presentation and providing note-takers.
Riddell and Weedon (2006) observed that the students they interviewed had
limited awareness of their right to request alternatives to written examinations
and coursework. Students from two studies expressed the view that it was not
possible for lecturers to modify their teaching to fit individual needs (12; 14). To
the contrary, other students expressed the expectation of receiving adjustments
to fit their individual needs (12). Yet, students did not recur to adjustments in all
their classes (5), sometimes to see whether they could carry on without external
help (‘I didn’t use my accommodations because I wanted to see how I would do
without them this semester’, 5, p. 145). Access to adjustments was contingent
on the students’ willingness to disclose their diagnosis of dyslexia, which could
be costly in psychological terms. Some students expressed ambivalence regarding
this matter (13b). In particular, although they did not want to draw attention to
their condition, at the very least they wanted to avoid difficult situations
(‘You come in, you’re like, “Oh God please don’t give me anything to read or
write you know, to read out in front of anybody” ’, 13b, pp. 67–68) or to access support and adjustments. Some students were reportedly reluctant to self-disclose as
dyslexic for fear of discrimination (‘I am wary of disclosing my disability because I
am concerned how I would be labelled’, 11, p. 248). Others regarded such disclosure
as strategic to access support. Finally, some students preferred to be open about
their dyslexia and to inform others at the first available opportunity.
Using Assistive Technologies and Information and Communication Technologies
Eight studies (3; 4; 5; 6; 10; 11; 12; 14) addressed the use of ATs and ICTs. Regarding ATs, several students found the computer to be useful, insofar as word
processing grants greater control over the medium. In addition, while the spellchecker spots mistakes, it can also present limitations (e.g., ‘The spellchecker
displays a list of possible words, and I still don’t know which one is correct’, 14,
p. 96). Some students found voice-recognition software useful (1; 11; 12), and
mixed opinions were observed about tape-recording lectures. For some, this
was a useful strategy in compensating for the difficulty of listening to a lecturer’s
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
The Inclusion of Students with Dyslexia in HE
363
voice while simultaneously taking notes (12). For other students, tape-recording
lectures was not a viable solution (e.g., because they did not have time to listen
to the tapes afterwards; 5).
The main reported advantage of ICTs was that they enhanced student control
over the learning process. For instance, ICTs enabled the students to highlight
text, to maintain position while reading (3; 4), to engage in mind-mapping (10)
and, more broadly, to employ visual models or working styles (3; 4; 10). ICTs were
also useful in retrieving information (3; 4; 10) and helping with auditory memory
(10). Electronic learning environments—such as the ones used in online courses
(5; 10)—helped to slow down the flow of information presentation, making the
learning process more predictable and enabling repetition. Reading on screen
(which allows one to adjust font type, size and colour) increased reading speed.
Self-pacing is an ingredient of student control, with the students being able to
proceed at their own speed as compared, for instance, with straight lectures
(‘I could go slow if I didn’t understand something and repeat it over and over until
I got or I could go quickly if I did get it’; 5, p. 135). Therefore, the material can be
accessed repeatedly at one’s own pace. The students found online courses to be
more accessible when the volume of information (3; 4; 10) was reduced and concise materials were offered (5). Additionally, the students saw summaries of contents as useful (5). The opportunity to enhance student control over the learning
process could boost confidence and have a positive impact on self-image including
a more balanced understanding of one’s own strengths and a sense of self-efficacy
(‘I feel the Pebble-pad has aloud (allowed) me to be at the same level as everyone
else and in some cases ahead of them. I’m sure you can imagine what this does to
my confidence and self-esteem’, 10, p. 54).
DISCUSSION
A systematic review was performed to retrieve and synthesize the available evidence on how the inclusion of students with dyslexia can be fostered in mainstream educational institutions. After initially mapping the available literature and
through progressive refinement of the initial question, the in-depth stage of the
review focused on the following research question: How do students with dyslexia
experience the impact of teaching, adjustment and support in HE?
In the thematic area of being identified as dyslexic, the findings suggest that
although students can react negatively when originally informed of their dyslexia
diagnosis, the diagnosis brings awareness of one’s own condition and thus an opportunity to improve the learning experience. While previous school experiences
may have produced the feeling of being ‘stupid’, the diagnosis provides an explanation for the difficulties with literacy. As Norwich (2009) stated, ‘this positive selfconception arises from a key aspect of the historic meaning of dyslexia, which
excludes low intellectual abilities as a cause of the literacy difficulties’ (p. 186). In
time, students can acquire a more balanced view of their strengths and weaknesses
and develop cognitive and affective strategies that enhance their learning experience. The diagnosis can also have a motivational effect by encouraging the students
to pursue HE.
In the area of interactions with academic staff, the students positively evaluated
teaching approaches that went beyond traditional formats (such as straight
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
364
M. Pino and L. Mortari
lecturing). They favoured teaching styles that allowed them to employ the full
range of their communication and expression abilities to exhibit their knowledge
and competence. This became possible in learning environments that provided
ample opportunities to access study materials in multiple formats and to autonomously regulate the speed of information processing. The possibility of gaining
control of the medium was, hence, a key component of successful learning experiences and was enhanced by the use of ICTs. The students also favoured interactive and student-centred teaching approaches.
In the area of accessibility and adjustments, individualized adaptation and lenience
helped the students to navigate HE, especially in the assessment domain. Some students felt that standard adjustments (such as the use of a laptop and extended
time) were sufficient. Others felt discriminated against by the dominance of written assessment because it does not enable them to fully express their actual level
of knowledge and competence (13). As Hanafin, Shevlin, Kenny, and Mc Neela
(2007) stated, ‘the over-reliance on written techniques of assessment can exclude
many learners from successful assessment experiences as can the practice of
requiring learners to communicate all they know about a topic within a limited
and rigidly imposed time frame’ (p. 438).
Students can be unaware of their right to require adjustments and modifications
in the practices of assessment. This finding raises the need to inform students of
their right to require adaptations and support. Sometimes, students prefer not
to use adjustments because they want to prove to themselves or to others that
they can succeed without external help. At the same time, this preference might
reflect students’ adaptation to teaching environments that are unreceptive to
diverse student needs. The results of this systematic review further show that disclosing one’s own dyslexia is sometimes costly in psychological terms and that
many students may prefer to give up the opportunity to receive support to avoid
embarrassment or stigmatization, especially when they have suffered these effects
in previous school experiences. The implication is that HEIs should work to establish environments where the disclosure of dyslexia is welcomed. Likewise,
adopting a cultural view of dyslexia not as a deficit, but as a neurological or cognitive diversity that has strengths and weaknesses similar to any other form of neurological or cognitive functioning (Griffin & Pollak, 2009), can be helpful. Finally,
some students positively valued organizational practices in which the Disability
Office informs all academic staff, sparing students from having to discuss their dyslexia with each teacher (7; 12; 14). This opportunity should be provided to those
students who consider it appropriate.
Implications for Practice
Providing opportunities to identify one’s own dyslexia
As far as the perspective of the students themselves is concerned, the identification of one’s own dyslexia is an important step towards a more successful and
comfortable experience in HE. People who have not been identified earlier should
have the opportunity to discover and learn about their own dyslexia while attending HE. Although in HE it is primarily the students’ responsibility to report their
own disabilities or SpLDs (GAO, 2009), the available evidence shows that (1)
students can navigate pre-university education without being aware of their own
dyslexia and that this is associated with negative school experiences, and (2) if
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
365
The Inclusion of Students with Dyslexia in HE
academic staff members are aware of the possibility of dyslexia, they can advise
students to be tested. This highlights the need to adopt strategies at the institutional level to inform academic staff that dyslexic students may be among the
student body.
Staff training
Teachers’ lack of dyslexia awareness can have a significant impact on students’
learning experience. Our findings also show that rapport between students and
tutors contributes to a positive learning experience, in which personalized advice
and encouragement are also provided. The element of emotional and relational
support is important to motivate students to overcome the obstacles and barriers
that they encounter in their learning experiences. These findings further support
the recommendation to raise academic staff’s awareness of dyslexic students’
needs.
Peer support
Emotional and relational support can be provided by both professional staff
and peers (11). Some students claimed that they would benefit from meeting
other students with dyslexia (14). Indeed, some guidelines for academic staff
suggest that peer support should be encouraged (Lockley, nd). This type of support
can be particularly useful in the initial phase, after receiving a diagnosis of dyslexia,
which can destabilize students’ self-image and generate feelings of shock. There is
nevertheless a need to explore the impact of peer support initiatives in future
research.
A flexible combination of universal design for learning and individualised support
There is evidence supporting the claim that UDL can respond to some of the challenges involved in teaching and accommodating students with dyslexia in inclusive
settings. Nevertheless, HEIs should also provide individualized support and adjustments because learning needs vary among students and across different territories
of their learning experience. Our findings show that not all students used adjustments, and students did not use adjustments in all courses. The available evidence
suggests that academic staff should work at different levels to (1) design courses in
flexible and multi-layered ways, for example by incorporating multiple formats of
content-delivery to meet the needs of diverse students, and (2) provide individualized adjustments to students who display further difficulties and special needs
(in collaboration with university disability services). This view is compatible with
Norwich and Lewis’ (2001) notion of continua of teaching approaches, implying
that ‘the various strategies and procedures which make up teaching can be considered in terms of whether they are used more or less in practice’ (p. 325). Evidence
from this systematic review indicates that students positively experience flexible
course designs that offer the following: (1) opportunities to access contents in
multiple formats; (2) use of media to enhance student control and self-pacing
(as evidenced in studies focusing on the use of ICTs); and (3) additional forms of
support to meet individual needs. Research is needed to ascertain how a multitiered, multi-faceted course design can be implemented in HE and how it might
be received by students with and without dyslexia.
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
366
M. Pino and L. Mortari
Directions for Future Research
The studies retrieved in this systematic review had descriptive designs and
overwhelmingly explored students’ own perspectives on the inclusion of people
with dyslexia in HE. Future research should extend this evidence base by both
exploring other people’s perspectives regarding dyslexia and inclusion in HE
(e.g., academic staff) and carrying out outcome evaluations of interventions designed to enhance the inclusion of students with dyslexia in HE.
Three studies (4; 5; 10) show how it is possible to design inclusive courses to
simultaneously meet the learning needs of students with and without dyslexia;
however, they mainly provide evidence of their impact on dyslexic students’ experiences. More research is needed to compare how dyslexic and non-dyslexic students experience working together and utilizing the same learning tools and
materials. This type of research is needed to further explore the feasibility and
perceived effectiveness of the UDL approach.
APPENDIX
CRITICAL APPRAISAL TOOL
Adaptation of the tool published by the EPPI Centre (Nind et al., 2004), integrated with
elements of the CEBMa (nd) appraisal tool and the Cochrane Qualitative Methods &
Implementation Group chapter on the critical appraisal of qualitative studies
(Hannes, 2011).
STUDY
Title
CRITICAL APPRAISAL
A. INTERNAL METHODOLOGICAL COHERENCE
Notes
1. Did the study address a clearly focused question or issue?
2. Is the research method appropriate for answering the research question?
3. Is the context clearly described?
4. Are the participants clearly described?
5. Is the sample design appropriate for the research focus?
6. Are the data-collection procedures appropriate for the research focus?
7. Are the procedures for data analysis reliable?
Check for the use of quality control measures, for example member
checks, peer debriefing, attention to negative cases, independent
analysis of data by more than one researcher, verbatim quotes,
persistent observation, recursive design or constant reviewing of
emergent themes and accurate representation of participants’ voices
8. Is the research process traceable and clearly documented?
Check for the use of quality control measures, for example
inclusion of sufficient data to assess credibility of conclusions,
Yes/no
Yes/no/can’t tell
Yes/no
Yes/no
Yes/no/can’t tell
Yes/no/can’t tell
Yes/no/can’t tell
Yes/no
(Continues)
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
367
The Inclusion of Students with Dyslexia in HE
(Continued)
whether evidence can be inspected independently; reflexivity;
peer review; audit; calculation of inter-rater agreement; and
triangulation
9. Inclusion of enough information on researchers’
orientations/background?
Check for the use of quality control measures, for example
attention to the effects of the researcher during all steps of
the research process; reflexivity; and information on the
researcher’s background, education, perspective and school
of thought
Yes/no
Note: Questions 5, 6 and 7 bear on the credibility of findings. Questions 3 and 4 bear on the
transferability of findings. Question 8 bears on the dependability of findings. Question 9 bears on
the confirmability of findings.
Overall internal methodological coherence: high/medium/low
B. RELEVANCE of the study focus for the review question
Notes
10. Does the studies focus on aspects that are relevant for the inclusion of
dyslexic students in HE?
For example, teaching approaches, assessment approaches, support
services, identification/diagnosis of dyslexia in HEIs, use of ATs
and ICTs, peer support, and relationship/communication with
academic staff
11. Does the study provide access to dyslexic students’ views?
Yes/no
Yes/no
Overall relevance of the study focus for the review question: high/medium/low
SUMMARY OF STUDY QUALITY
Relevance for the review question
Internal methodological coherence
High
Medium
Low
High
Medium
Low
High
High-medium
Medium
High-medium
Medium
Medium-low
Medium
Medium-low
Low
Additional notes
REFERENCES
Barnett-Page, E., & Thomas, J. (2009). Methods for the synthesis of qualitative research: A critical review. BMC Medical Research Methodology, 9. doi: 10.1186/1471-2288-9-59
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi: 10.1191/1478088706qp063oa
British Dyslexia Association [BDA]. (2013). Dyslexia and specific learning difficulties in adults.
Retrieved from http://www.bdadyslexia.org.uk/about-dyslexia/adults-and-business/dyslexia-andspecific-learning-difficulties-in-adu.html [1 November 2013]
Carter, C., & Sellman, E. (2013). A view of dyslexia in context: Implications for understanding differences in essay writing experience amongst higher education students identified as dyslexic. Dyslexia,
19, 149–164. doi: 10.1002/dys.1457
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
368
M. Pino and L. Mortari
Centre for Evidence-Based Management [CEBMa]. (nd). Critical appraisal of a qualitative study. Retrieved from http://www.cebma.org/wp-content/uploads/Critical-Appraisal-Questions-for-a-Qualitative-Study.pdf [1 November 2013]
Cornett-DeVito, M. M. W. (2005). A front row seat: A phenomenological investigation of learning
disabilities. Communication Education, 54, 312–333. doi: 10.1080/03634520500442178
Diraä, N., Engelen, J., Ghesquière, P., & Neyens, K. (2009). The use of ICT to support students with
dyslexia. In A. Holzinger (Ed.), USAB ’09 proceedings of the 5th symposium of the workgroup
human–computer interaction and usability engineering of the Austrian computer society on HCI
and usability for e-inclusion (pp. 457–462). Berlin Heidelberg: Springer.
Dixon, M. (2004). Disability as a vehicle for identifying hidden aspects of human activity: inclusive design and dyslexia in educational software development. In C. Stary & C. Stephanidis (Eds.), Usercentered interaction paradigms for universal access in the information society (pp. 254–261). Berlin
Heidelberg: Springer.
Dixon-Woods, M., Agarwal, S., Young, B., Jones, D., & Sutton, A. (2004). Integrative approaches to
qualitative and quantitative evidence. London: Health Development Agency. Retrieved from http://
www.nice.org.uk/niceMedia/pdf/Integrative_approaches_evidence.pdf [1 May 2014]
Dziorny, M. A. (2012). Online course design elements to better meet the academic needs of students
with dyslexia in higher education. UMI Dissertations Publishing, University of North Texas.
Education Resources Information Center [ERIC]. (nd). Retrieved from www.eric.ed.gov/ (1 November 2013)
Farmer, M., Riddick, B., & Sterling, C. (2002). Dyslexia and inclusion: Assessment and support in
higher education. London: Whurr Publishers.
Government Accountability Office [GAO]. (2009). Higher education and disability. Report to the
Chairman, Committee on Education and Labor, House of Representatives. GAO-10-33. Retrieved
from http://www.gao.gov/new.items/d1033.pdf [1 November 2013]
Griffin, E., & Pollak, D. (2009). Student experiences of neurodiversity in higher education: Insights
from the BRAINHE project. Dyslexia, 15, 23–41. doi: 10.1002/dys.383
Hadjikakou, K., & Hartas, D. (2008). Higher education provision for students with disabilities in
Cyprus. Higher Education, 55, 103–119. doi: 10.1007/s10734-007-9070-8
Hanafin, J., Shevlin, M., Kenny, M., & Mc Neela, E. (2007). Including young people with disabilities:
Assessment challenges in higher education. Higher Education: The International Journal of Higher
Education and Educational Planning, 54, 435–448.
Hannes, K. (2011). Chapter 4: Critical appraisal of qualitative research. In J. Noyes, A. Booth, K. Hannes,
A. Harden, J. Harris, S. Lewin, & C. Lockwood (Eds.), Supplementary guidance for inclusion of qualitative
research in Cochrane systematic reviews of interventions. Version 1 (updated August 2011). Retrieved
from http://cqrmg.cochrane.org/supplemental-handbook-guidance [1 November 2013]
Higher Education Statistics Agency [HESA]. (nd). 2011/12 first year students by disability. Retrieved
from http://www.hesa.ac.uk/index.php/content/view/1897/239/ [1 November 2013]
Hughes, J., Herrington, M., McDonald, T., & Rhodes, A. (2011). E-portfolios and personalized learning: Research in practice with two dyslexic learners in UK higher education. Dyslexia, 17, 48–64. doi:
10.1002/dys.418
Kirkland, J. (2009). The development of protocols for assessment and intervention at university for
students with dyslexia. In G. Reid (Ed.), The Routledge companion to dyslexia (pp. 261–264). New
York, NY: Routledge/Taylor & Francis Group.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
Lockley, S. (nd). Dyslexia and higher education: Accessibility issues. The Higher Education Academy.
Retrieved from http://www.heacademy.ac.uk/assets/documents/resources/database/id416_dyslexia_
and_higher_education.pdf [1 November 2013]
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009). Preferred reporting
items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6, e1000097.
doi: 10.1371/journal.pmed1000097
Nind, M., Wearmouth, J., Collins, J., Hall, K., Rix, J., & Sheehi, K. (2004). A systematic review of pedagogical approaches that can effectively include children with special educational needs in mainstream
classrooms with a particular focus on peer group interactive approaches. London: EPPI-Centre,
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
The Inclusion of Students with Dyslexia in HE
369
Social Science Research Unit, Institute of Education. Retrieved from http://eppi.ioe.ac.uk/cms/
LinkClick.aspx?fileticket=RH5L9mk99AM%3D&tabid=331&mid=1250 (9 May 2012)
Norwich, B. (2009). How compatible is the recognition of dyslexia with inclusive education? In G.
Reid (Ed.), The Routledge companion to dyslexia (pp. 177–192). New York, NY: Routledge/Taylor
& Francis Group.
Norwich, B., & Lewis, A. (2001). Mapping a pedagogy for special educational needs. British Educational
Research Journal, 27, 313–329. doi: 10.1080/01411920120048322
Noyes, J., & Lewin, S. (2011a). Chapter 5: Extracting qualitative evidence. In J. Noyes, A. Booth, K.
Hannes, A. Harden, J. Harris, S. Lewin, & C. Lockwood (Eds.), Supplementary guidance for inclusion
of qualitative research in Cochrane systematic reviews of interventions. Version 1 (updated August
2011). Retrieved from http://cqrmg.cochrane.org/supplemental-handbook-guidance [1 November
2013]
Noyes, J., & Lewin, S. (2011b). Chapter 6: Supplemental guidance on selecting a method of qualitative
evidence synthesis, and integrating qualitative evidence with Cochrane intervention reviews. In J.
Noyes, A. Booth, K. Hannes, A. Harden, J. Harris, S. Lewin, & C. Lockwood (Eds.), Supplementary
guidance for inclusion of qualitative research in Cochrane systematic reviews of interventions.
Version 1 (updated August 2011). Retrieved from http://cqrmg.cochrane.org/supplemental-handbook-guidance [1 November 2013]
Oliver, S., & Peersman, G. (2001). Using research for effective health promotion. Buckingham Philadelphia: Open University Press.
Palfreman-Kay, J. (2000). The experiences of adult students with dyslexia enrolled on ‘Access To
Higher Education’ programmes. Leicester: De Montfort University.
Parry, R., & Land, V. (2013). Systematically reviewing and synthesizing evidence from conversation
analytic and related discursive research to inform healthcare communication practice and policy:
An illustrated guide. BMC Medical Research Methodology, 13. doi: 10.1186/1471-2288-13-69
Petticrew, M., & Roberts, H. (2006). Systematic reviews in the social sciences. Malden, MA; Oxford:
Blackwell Publishing.
Pollak, D. E. (2005). Dyslexia, the self and higher education: Learning life histories of students identified as dyslexic. Stoke on Trent: Trentham.
Riddell, S., Tinklin, T., & Wilson, A. (2005). Disabled students in higher education: Perspectives on
widening access and changing policy. London: Routledge.
Riddell, S., & Weedon, E. (2006). What counts as a reasonable adjustment? Dyslexic students and the
concept of fair assessment. International Studies in Sociology of Education, 16, 57–73. doi: 10.1080/
19620210600804301
Riddick, B., Farmer, M., & Sterling, C. (1997). Students and dyslexia: Growing up with a specific learning difficulty. London: Whurr Publishers.
Taylor, G., & Palfreman-Kay, J. M. (2000). Helping each other: Relations between disabled and nondisabled students on Access programmes. Journal of Further & Higher Education, 24, 39–53. Retrieved
from http://www.tandfonline.com/toc/cjfh20/current (1 June 2012)
UNESCO. (1994). World conference on special education needs: Access and quality. Paris:
UNESCO.
©2014 The Authors. Dyslexia published by John Wiley & Sons, Ltd.
DYSLEXIA 20: 346–369 (2014)
Purchase answer to see full
attachment