The Interplay between Dyslexia, Anxiety, and Educational Attainment among Young Adults in Iceland

Abstract

The chapter will explore the interplay between dyslexia, anxiety, and educational attainment of young adults in Iceland, a small Nordic welfare state, placing emphasis on inclusive education. A survey, representative of 18- to 24-year-olds in Iceland, and qualitative interviews with 10 young adults were used to gain an understanding of the association between being diagnosed with dyslexia, having experienced anxiety, and young people’s education path. Findings from the survey show that being diagnosed with dyslexia was associated with anxiety and educational attainment. However, experiencing anxiety depended on how old the young adults were when they were diagnosed with dyslexia. Those who were diagnosed at an early age did, in general, not show symptoms of anxiety and were more likely to have continued their studies than those who were diagnosed as teenagers. The qualitative interviews supported the survey-results, as participants described how having to read out loud or receive special education caused anxiety and the feeling of exclusion. The findings indicate that providing support for children with reading difficulties, at an early age, can prevent future anxiety and school drop-out. The findings also raise a question on how well the Icelandic school system conforms to the policy of inclusive education.

1. Introduction

Icelandic legislation places emphasis on equal opportunities for all. Equal opportunities include equal access to education that is supported by an emphasis on inclusive education that was legalised in Iceland in 2008. The Act of Elementary Schools, from 2008, [1] states that all students have the right to receive suitable teaching and support. The 17th article of the act addresses students with special needs. The article states that students have the right to equal treatment and that their educational needs are to be met in public elementary schools, without exclusion, regardless of their physical or mental abilities. An inclusive school thereby addresses groups of students that in some way or the other may be at risk of not being able to participate fully in learning, for example, due to lack of Icelandic language skills, disabilities, or poor social and economic conditions [2]. An inclusive school requires teachers and other staff to provide all students with the necessary support, to remove barriers in the learning environment, and thereby enable participation in education [3].

In this chapter, we present findings from a study that touches upon whether the objectives of providing suitable teaching and support, in accordance with inclusive education, have been achieved in the Icelandic school system in the case of dyslexic children. Dyslexia is a good example of a learning disability that has social and emotional consequences. According to international literature, poor academic performance and stigma associated with dyslexia may impact students’ emotional well-being and have several social consequences that can in some cases follow the student into adulthood [4]. It is therefore important to identify the barriers that young people with dyslexia face, and to learn whether the provision of support at an early age can diminish the negative consequences of dyslexia on emotional well-being and educational attainment. In this study, special emphasis is placed on analysing the association between dyslexia and anxiety and learning whether dyslexic youth differ in their educational attainment compared to young people that have not been diagnosed with dyslexia. An emphasis is also placed on identifying differences in anxiety and educational attainment in those who were diagnosed with dyslexia at an early age and those who received a diagnostic after the age of 10.

The study will indicate how well the Icelandic school system conforms to the policy of inclusive education. It is of great importance to gain an increased understanding of how a dyslexia diagnostic is associated with anxiety and educational attainment, as the literature suggests that the way people cope with the learning difficulties, rather than the difficulties themselves, predicts how they will succeed in adult life [5].

2. Study background

Inclusive education is an ideology that places primary focus on removing barriers to school participation [6]. However, the way it is adapted and integrated varies between countries, communities, and schools [7]. The overarching aim of inclusive education is to combat discrimination, as well as prevent student dropout, by ensuring that all students have access to meaningful, high-quality education in their local schools [8]. This means that schools must provide sufficient support and remove barriers, for all students to thrive. The emphasis on removing barriers is firmly rooted in the social model of disability, an ideology that maintains that people’s limitations stem from hindrances in society, not by their impairment or difference [9]. In light of this perspective, the objective of providing inclusive support at schools is to limit the barriers that hinder participation and learning, instead of placing emphasis on children’s lack of physical or cognitive ability. Thus, instead of placing students with special education needs in specially designed programs or schools, the aim is to provide sufficient support in order for all children to have equal access to education in their local schools [10].

Icelandic law is rooted in the ideology mentioned above. The Act on Elementary Schools, from 2008, emphasises that students have the right to equal treatment and that their educational needs must be met, regardless of their physical or cognitive abilities. Furthermore, the act places emphasis on supportive services instead of special needs education [1]. The emphasis on inclusiveness is also stressed in the National Curriculum for Elementary Schools as it underscores the obligation of schools to effectively educate all children [11]. Accordingly, every child has the right to receive a suitable education within the Icelandic elementary school system.

However, inclusive education can be a challenge. International research shows that at times, schools have failed to provide support that conforms to the policy of inclusive education. For example, a study by Nishan [12] revealed that teachers experience a lack of resources and solutions. Moreover, Torombe [13] found that there are too many students in classrooms and that there is a lack of knowledge about the different student needs. Research suggests that many teachers feel they lack the knowledge and competency to teach within the inclusive school parameters and consider it the role of other professionals to attend to students with diverse learning needs [14]. Similarly, Hardin and Hardin [15] maintain that even though most teachers teach students with differing special needs each day, there are always those who believe they lack the capacity to satisfactorily meet those needs. In Iceland, the Ministry of Education, Science and Culture [16] did an assessment on inclusive education and found that following the implementation of the Act on Elementary Schools in 2008, schools suffered from insufficient funds and resources. Furthermore, in a comparative analysis of inclusive schools in Iceland and Canada, Köpfer and Óskarsdóttir [17] found that in both countries there still exists an emphasis on the “special needs” of children, which impacts the support that is provided. Thus, instead of removing barriers in the school environment, educational practises are still in some ways focused on the student’s ability instead of finding ways to provide access to quality education for all students.

Dyssegaard et al. [18] attest that the success of inclusive education for a student with diverse needs rests on the resources in the schools, teacher access to continued professional development, and the availability of professionals with knowledge of diverse teaching methods that suit students with diverse learning needs. Teachers play a key role in student learning, as they support students’ individual needs and cater to their developmental needs, as well as recognize and address learning difficulties and respond with appropriate solutions. These responsibilities can be challenging for teachers and therefore there is a need for adequate professional support to enable teachers to meet the diverse needs of students [19].

Dyslexia is an example of a learning disability that can produce academic inequality if schools fail to provide sufficient support. Dyslexia is not considered related to people’s IQ [20], but generally results in people having difficulty identifying words accurately and deficiencies in spelling skills [21, 22]. A review of international literature on how dyslexia may impact emotional well-being shows that dyslexia can have a range of both direct and indirect consequences. Direct consequences appear in poor academic capabilities and work performance. These difficulties are often accompanied by stigma, and those with dyslexia often feel humiliated, which can lead to negative self-evaluation. A negative self-evaluation can then have various consequences, such as low self-confidence, problems in social relations, low motivation, behavioural problems, and mental distress [23].

It is possible that negative self-esteem, and its consequences, could be prevented by diagnosing dyslexia at a young age, so that appropriate support can be provided. A significant discovery from Australian research was that teachers approached children in need of support differently when learning difficulties were explicitly identified, for example with a dyslexia diagnosis. Students with formally labelled learning difficulties tended to receive more effective support from their teachers compared to those with learning difficulties that were not formally identified. For teachers, a labelled learning difficulty provides a sense of clarity when selecting appropriate strategies to address students’ specific needs [4]. It is important that children and young people with dyslexia receive sufficient support that meets their individual needs, since dropout from education is highest among those with learning difficulties of some kind [24, 25]. Those who drop out of school can face reduced quality of life, various psychosocial difficulties, and are at risk of having to rely on welfare services to support themselves [26]. Furthermore, an Icelandic study found that 33% of people with a disability or rehabilitation pension, under the age of 30, had been diagnosed with dyslexia. These results indicate that the lack of educational support for young dyslexic people can affect their health and lead to drop out from the labour market and education [25, 27].

3. Method

The study applies an explanatory mixed methods design, which consists of collecting quantitative data and then collecting qualitative data to help explain the relationships or trends found in the quantitative data [28]. In the following section, quantitative results will be at the forefront, revealing differences in educational attainment and anxiety between dyslexic and non-dyslexic youth. Qualitative interviews with young dyslexic people then give the possibility to develop a more in-depth understanding of the reasons for anxiety and drop-out from education and experiencing anxiety.

For the survey, a random sample of 4000 individuals, aged 18–24, was drawn from the Icelandic National Register. An introductory letter was sent to the legal residence of the young people in the sample, in which the purpose of the study was described. The letter also contained the URL to complete the survey online. Later, sampled members who had a phone number listed in the telephone directory were called, reminded of the survey, and invited to provide their email address to receive the survey by email. Since the response rate was poor, a decision was later made to visit the sampled individuals’ legal residence and conduct the survey face-to-face. Data collection took place from August 2022 to March 2023. The total number of participants in the survey was 1036 resulting in a 26% response rate.

The questionnaire was designed by one of the researchers, in cooperation with staff at the Social Science Research Institute at the University of Iceland. Most questions were created specifically for the study, but the questionnaire also contained items from the GAD-7 anxiety scale (General anxiety disorder). The survey was fielded in both Icelandic and English. Data were then analysed using the chi-square test, to determine statistical significance between youth diagnosed with dyslexia and others. The association between dyslexia and anxiety was analysed using linear regression models.

Figure 1 shows the prevalence of dyslexia in the group of survey respondents. It was found that more than 20% of the respondents were diagnosed with dyslexia. A higher percentage of men than women had dyslexia, and it was most common that the respondents had received the diagnosis between the ages of 10 and 15.

Figure 1.

Percentage of survey respondents that are diagnosed with dyslexia.

At the end of the survey, those who reported that they were diagnosed with dyslexia were asked if they were willing to take part in a qualitative interview on the matter. The guide used for the interviews was divided into three main themes. First, the interviewees were asked to describe their experiences with the dyslexia diagnosis. Secondly, they gave an account of the school system and the assistance they received or would have needed at school. Finally, they were asked whether they had experienced anxiety and how they associated their own dyslexia with anxiety. The interviews were carried out over the phone, recorded, and transcribed. The data was analysed by applying template analysis using the interview guide as the coding template [29]. The interviewees were all born around the turn of the last century. Ten people were interviewed, five women and five men. The interviewees had diverse educational backgrounds and held different positions in the labour market.

4. Results

We now present the results of the mixed-method study. We first present results on how a dyslexia diagnostic was associated with anxiety, following results on the educational attainment of those diagnosed with dyslexia compared to those who do not have a dyslexia diagnosis.

4.1 Associating dyslexia with anxiety

In the survey, anxiety was measured with seven questions belonging to the GAD-7 (General anxiety disorder assessment) scale. The participants were asked how often in the past two weeks they had been nervous, worried, restless, angry, and afraid. Average responses to the questions were then used to create an anxiety scale. The scale has a value from 1 to 4, the higher the value, the greater the anxiety. The mean of the scale was 2.05 (standard deviation = 0.72). Figure 2 shows the average scores on the anxiety scale for those diagnosed with dyslexia after the age of 10, those diagnosed with dyslexia before the age of 10, and for the participants without a dyslexia diagnosis. Although there were limited mean differences between the groups (p = 0.197), the group diagnosed with dyslexia after the age of 10 was slightly more anxious than the group diagnosed with dyslexia before the age of 10 and the non-dyslexic group.

Figure 2.

Anxiety symptom scale scores, by dyslexia diagnosis.

The association between dyslexia and anxiety was further analysed using linear regression models. The purpose was to see if there was an association between dyslexia and anxiety when controlling for factors that may be related to anxiety. The effects of gender, place of residence in childhood, whether the young people received help with homework, parents’ education, and respondents’ native tongue were controlled for.

The regression analysis revealed that women were generally more anxious than men. When examining how dyslexia was associated with anxiety, when controlling for the aforementioned factors, it was found that the association strengthened when gender was considered. Thus, it seems that dyslexia did not have a strong association with anxiety on its own, but when taking into account that women are more anxious than men, a dyslexia diagnosis adds considerably to anxiety. Results show that participants diagnosed with dyslexia before the age of 10 were no more anxious, on average, than those without a dyslexia diagnosis. On the other hand, those diagnosed with dyslexia after the age of 10 had more anxiety, on average, than those who were not dyslexic. Thus, it seems to matter whether the young people were diagnosed with dyslexia early or relatively late. Another result is that those who found it easy to get help with their studies at home had less anxiety than those who found it difficult. Anxiety was also lower among those who had a university-educated father than among those who had a father with a lower level of education (Table 1).

Independent variables	B
Female	0.407***
Dyslexia diagnosis before age 10 (ref.: no dyslexia)	0.029
Dyslexia diagnosis after age 10 (ref.: no dyslexia)	0.135*
Raised in Reykjavik metropolitan area	0.085
Easy to get help with homework in household	−0.318***
Mother has a university degree	0.066
Father has a university degree	−0.113*
Foreign language	0.025
Adjusted R^2	0.130

Table 1.

Results of linear regression analysis predicting anxiety.

*p <0.05; **p < 0.01; ***p < 0.001.

Thus, overall, the survey findings suggest that early intervention and support within the home environment significantly influence whether young people between the ages of 18 and 24 experience anxiety.

When asked about their experience with anxiety, the interviewees all said that they had dealt with anxiety or distress since childhood, and all associated their anxiety with school and their academic performance. Apart from one, they all had experienced dyslexia as their own incompetence, powerlessness, and “stupidity”. The powerlessness was often associated with having to read out loud. One mentioned that it was “difficult to stand in front of the class and read. [It is] one of the greatest humiliations one can experience”. Another said that he was “ashamed of reading so slowly and kind of hid the dyslexia”. The method used by the interviewee to “hide” his dyslexia was to read the texts so often that he remembered them by heart. Several interviewees used the word "stupidity” to describe how they felt at school. One interviewee, who was not diagnosed with dyslexia until late, said she felt “stupid and worthless” as she was never on par with her classmates academically, despite her hard work.

Several interviewees were in special education and experienced it in different ways. However, most of them had a negative experience. One said that her classmates asked a lot about the special education and why she did not get higher grades despite receiving “special help”, which gradually reduced her self-confidence. When being removed from the class to receive special education, the interviewees felt like something was wrong with them and that they were not part of the group, as mentioned by one of the young men. “You were taken out of the class, all the others remained. Then you missed class and were scolded for not knowing what was being discussed in class, but I was not in the class”. One interviewee described how she began to feel anxious at the time she was placed in special education, despite having otherwise been “socially strong”. Thus, it seems that the special education programmes have not always turned out to be the solution they were intended to be. Rather, the interviewees felt that they had two bad options to choose from. Either to be taken out of the group, and put in special education, or to be in the class and expose their weakness in front of their class.

The schooling and its individual aspects, such as reading, special education, tests, and more, caused anxiety for all interviewees. One described how he “was anxious about going to school” and another said that she “cried herself to sleep before an exam”. Reading tests were thought to be extremely anxiety-provoking as they revealed the interviewees’ greatest weaknesses. Many wondered about the practical value of speed-reading tests and what purpose they should serve. Speed reading is especially difficult for dyslexic children because “as soon as dyslexics start reading at high speed, their heads get confused”, as one pointed out.

Some participants directly associated the anxiety with dyslexia or rather with going to school with dyslexia. They felt they had “more anxiety than others” because of their dyslexia, and most said they were “still stressed” or had “occasionally mild panic attacks”. When asked, none of the interviewees had been offered help to deal with their anxiety. No school psychologist or other professional was available to help them understand and cope with their dyslexia or help them find their way in education. Several interviewees had sought psychological help in later years, but on their own initiative and at their own expense. The participants agreed on the importance of having easy access to psychological support and “learn about yourself”, or in the words of one interviewee, getting help “to find ways to avoid high stress and learn to deal with panic attacks”.

4.2 Educational attainment

Survey participants were asked about the highest level of education they had completed. Figure 3 shows that participants with a dyslexia diagnosis were more likely to have not studied further after completing elementary school, than participants who had not been diagnosed with dyslexia. Considerably more respondents with dyslexia had completed vocational training or 11–12% compared to 6% of participants without a dyslexia diagnosis. About 10% of the respondents who had not been diagnosed with dyslexia had completed a university education, 6% of those who had been diagnosed before the age of 10, and 3% of the participants who had been diagnosed with dyslexia after the age of 10.

Figure 3.

What is the highest level of education you have completed?

The participants who were not studying when the survey took place, were asked if they aimed to study in the near future. When the responses were analysed according to whether the participants were diagnosed with dyslexia or not, it was found that over half of those who were not diagnosed with dyslexia intended to study at a university, but the same held true for a much lower proportion, or just over a third of those who were diagnosed with dyslexia (Figure 4).

Figure 4.

Are you planning to study in the near future?

Respondents who were pursuing education at the time of the survey were asked about their specific type of study. The majority of those without a dyslexia diagnosis were enrolled in university programs, while the proportion was notably lower, ranging between 37% and 39% for individuals who had been diagnosed with dyslexia (Figure 5).

Figure 5.

What kind of studies do you do?

The interviewees’ narratives shed some light on why young people with dyslexia are more likely to have dropped out of school than those who do not have such a diagnostic. Results from the interviews revealed that participants did not feel they received sufficient support in school. The resources available in elementary school and the secondary schools were coloured films or papers, longer test time – one spoke of “extra 15 minutes” - and some had access to audio books. Although most felt that “some of them helped” they stressed that they “wished the school had sent [them] to have the diagnosis much earlier” and that they had been immediately assigned “individualized assistance” and provided with “flexibility in their studies”. In retrospect, the support that the interviewees said was lacking, was not only in the form of additional resources, but what one interviewee called “additional attention and follow-up”. Thus, the interviewee points out that the teachers should have “looked into the reasons” why he performed poorly at school, including sending him earlier to test for dyslexia. Then, after being diagnosed, the interviewees emphasised that the support needed to be tailored to the individual in question, instead of a limited and standardized, some kind of “one-size-fits-all” remedy, as one put it.

Several interviewees had received help with reading and other subjects in special education programmes. The interviewees gave a two-sided story when discussing special education. Some thought it was a relief to “go to a private room to read and not be in front of people”, as one person put it, but others found it “embarrassing to be removed from the group” and placed in another room to study. The classmates asked a lot of questions about where they had been and why, and this led to further discomfort. Many interviewees had in common that they experienced their own disorder as a “failure” or a deviation from the norm, and the special education classes supported the feeling of being “the black sheep”. In other words, the young people were made to feel that they were different, which is not in line with the policy of inclusive education.

Many of the interviewees talked about dyslexia having a series of negative consequences. Dyslexia led to insecurities related to reading, which affected most other studies: “When you have difficulty reading, you have difficulty focusing and then [studying] is not fun, one thing leads to another, like a domino effect” said one interviewee. Poor performance, often despite hard work, lack of information about dyslexia, and lack of resources and support made the interviewees feel “something is wrong with [them]”. In the interviews, emphasis was placed on the importance of being informed of one’s own diagnosis and at the same time being able to focus on one’s strengths. According to the interviewees, “all the emphasis was on reading and mathematics” and there was no space for art subjects. All the interviewees shared the opinion that “too much emphasis [was] on reading” and a few also specifically criticized the emphasis on reading at high speed, which is a problem for many people, especially dyslexics.

Many of the interviewees had at some point dropped out of high school or “switched high schools” and one had dropped out of school after elementary school. One interviewee reported having reached the point of “not caring anymore [in 9th/10th grade], [I was] apathetic and rebellious” although she later completed secondary school and another “gave up school and now works in the construction industry”. However, most of them had eventually finished secondary school, and some were undergraduate university students at the time the interviews were conducted.

5. Conclusion

The study produced novel findings on the importance of identifying dyslexia at an early age. The survey among young adults revealed that anxiety-related symptoms were more often experienced by those who had been diagnosed with dyslexia after the age of 10 than those who had been diagnosed under the age of 10 or did not have a dyslexia diagnosis. Interestingly, there was no difference in anxiety between those diagnosed with dyslexia before the age of 10 and those who were not dyslexic. Thus, it seems crucial for the well-being of young people to detect dyslexia early, so that it is possible to provide adequate support. Our findings are in line with the results of an Australian study which found that teachers approached children differently when learning difficulties were explicitly identified [24].

The qualitative interviews gave a more in-depth understanding of how and why dyslexic children start to develop anxiety. For the interviewees, anxiety was mainly related to academic performance and especially to reading, and to how the school dealt with their learning difficulties. The severity of the anxiety varied from one individual to the other, but the interviewees shared the feeling of shame associated with their learning difficulties, and those who had been in special education felt that when removed from the class, they deviated from the norm. The way the school made them different shows that in many ways the Icelandic schools still treat reading difficulties as an individual problem, which is not in line with the social model of disability and inclusive education.

The study also found that the educational attainment of dyslexic young people is in many respects different from that of those who have not been diagnosed with dyslexia. The former group is less likely to be in school and has a lower level of education than the latter group. The study thus highlights the importance of removing barriers in the educational environment of children with reading difficulties, in order to prevent school drop-out. One type of barrier is the emphasis on reading out loud and the ability to read fast. From the interviews, it can be concluded that the emphasis placed on reading promotes manifestations of anxiety in a group of children and young people in Iceland which can negatively influence their educational path. To conclude, in order to comply with the Act on Elementary schools no. 91/2008 and provide equal access for children to education, there is a need for re-evaluating the Icelandic school system and finding flexible and innovative ways to provide quality education for all students, regardless of their reading abilities.

Acknowledgments

The authors thank Dr. Guðný Gústafsdóttir for conducting the qualitative interviews. The research was funded by the Iceland Dyslexia Association.

Conflict of interest

The authors declare no conflict of interest.