Verantwoording en bronnen

Copyright © 2021 Nederlands Instituut van Psychologen (NIP), Nederlandse Vereniging van Pedagogen en Onderwijskundigen (NVO), Nederlands Kwaliteitsinstituut Dyslexie (NKD) en Landelijke Beroepsvereniging Remedial Teachers (LBRT).

Het Nederlands Instituut van Psychologen (NIP), de Nederlandse Vereniging van Pedagogen en Onderwijskundigen (NVO), het Nederlands Kwaliteitsinstituut Dyslexie (NKD) en de Landelijke Beroepsvereniging Remedial Teachers (LBRT) zijn de opstellers van de Brede vakinhoudelijke richtlijn Dyslexie. 

Deze beroepsverenigingen en dit kwaliteitsinstituut zijn intellectueel eigenaar van de richtlijn, de bijbehorende werkkaarten en de informatie voor ouders. 

De beroepsverenigingen en het kwaliteitsinstituut geven alleen onder één voorwaarde toestemming voor het verveelvoudigen van de tekst in deze publicaties, voor het opslaan van die tekst in een geautomatiseerd gegevensbestand en voor het openbaar maken ervan (elektronisch, mechanisch, door fotokopieën of op enige andere manier). Die voorwaarde luidt dat zij allemaal vermeld moeten worden als opstellers van de richtlijn. 

Deze richtlijn wordt regelmatig aangepast. Raadpleeg daarom altijd de websites van de beroepsverenigingen en het NKD voor de meest actuele versie. 

De oorspronkelijke richtlijn is in 2024 geherstructureerd. 

De vermeld(e) beroepsverenigingen, het kwaliteitsinstituut en de ontwikkelaars van de richtlijn Dyslexie zijn zich ervan bewust dat het hun taak is de aanbevelingen in deze richtlijn verantwoord en overtuigend te onderbouwen. Niettemin kunnen de beroepsverenigingen en het kwaliteitsinstituut geen aansprakelijkheid aanvaarden voor onjuistheden of onnauwkeurigheden die mogelijk – en onverhoopt – in deze richtlijn voorkomen. 

Een consortium van schrijvers heeft deze richtlijn geschreven in opdracht van het NIP, de NVO, het NKD en de LBRT. De projectorganisatie was belegd bij het Nederlands Jeugdinstituut. Dit project werd mogelijk gemaakt door financiering van het Ministerie van VWS en het Ministerie van OC&W.

Gebruik in referenties altijd ‘Brede vakinhoudelijke richtlijn dyslexie’ als titel van deze richtlijn.

Auteurs 

• Femke Scheltinga
• Jurgen Tijms
• Maaike Zeguers
• Marzenka Rolak
• Elise de Bree

Inhoudelijke eindredactie

• Boukje Toering
• Maud van Druenen
• Pol Ghesquière
   

Aanleiding en achtergrond

Naar aanleiding van de stijging van het aantal dyslexieverklaringen heeft dyslexie in Nederland de afgelopen jaren veel aandacht gekregen. Deze aandacht kwam van het werkveld, de politiek, het Ministerie van Onderwijs, Cultuur en Wetenschap (OCW) en het Ministerie van Volksgezondheid, Wetenschap en Sport (VWS). 

Het Nederlands Instituut van Psychologen (NIP), de Nederlandse Vereniging van Pedagogen en Onderwijskundigen (NVO) en het Nederlands Kwaliteitsinstituut Dyslexie (NKD) stelden in 2016 een position paper op. Daarin noemden zij enkele speerpunten om de dyslexieketen van onderwijs en zorg te verbeteren. Eén van die speerpunten was de ontwikkeling van een vakinhoudelijke richtlijn Dyslexie.

Eind 2017 gaven de beroepsverenigingen NIP, NVO en de Landelijke Beroepsvereniging Remedial Teachers (LBRT) samen met het NKD opdracht tot de ontwikkeling van deze vakinhoudelijke richtlijn dyslexie.

Ontwikkelproces

In totaal 312 praktijkprofessionals uit zorg en onderwijs bevestigden via een quick-scan het belang van de uitgangsvragen in deze richtlijn. Deelnemers aan onze klankbordgroep bevestigden dat belang ook. Deze klankbordgroep bestond uit vertegenwoordigers van dertien organisaties die – beleidsmatig of praktisch – te maken hadden met dyslexie. 

Op basis van eerdere ervaringen met de ontwikkeling van de richtlijnen jeugdhulp en jeugdbescherming is in de tweede fase van het traject de programmastructuur vormgegeven. Zo kwam er in deze fase naast de klankbordgroep ook een ontwikkelwerkgroep, een stuurgroep, een richtlijnadviesgroep, een projectteam, deelwerkgroepen en een cliëntenvertegenwoordiging.

Een belangrijke actie in het ontwikkelingstraject betrof de ‘proefinvoer’ in het najaar van 2020. Dit hield in dat in die periode tachtig gedragsdeskundigen en lees- en spellingspecialisten uit het onderwijs en de zorg met de conceptrichtlijn werkten. In de anderhalf jaar daarvóór hadden betrokken groepen al meermalen feedback gegeven op de conceptrichtlijn. Op basis van hun commentaar en aanbevelingen had de ontwikkelwerkgroep de conceptrichtlijn diverse keren bijgesteld. Nu was het aan de tachtig gebruikers om hun bevindingen te delen. Zij deden dit via een digitale vragenlijst. Aanvullend was er een focusgroepbijeenkomst met een aantal van de respondenten.

Tegelijk met deze proefinvoerfase vond de commentaarfase plaats. Leden van NVO, NIP, LBRT, NKD, NVLF, Balans en DCI gaven daarin uitgebreid feedback op de conceptrichtlijn die er toen lag. De ontwikkelaars verwerkten de feedback uit de de proefinvoer- en commentaarfase zorgvuldig. Daarbij keken ze goed of de input paste binnen de kaders van de opdracht en inhoud van de richtlijn. Ook zochten ze optimale afstemming met het protocol PDDB 3.0: ze wilden ervoor zorgen dat de uiteindelijke richtlijn zo goed mogelijk zou aansluiten op dit protocol. Daarmee wilden ze bijdragen aan eenduidigheid in de aanpak van dyslexie. Al deze inspanningen leidden tot de definitieve richtlijn.

Tijdens de ontwikkeling van de richtlijn – inclusief de proefinvoeringsfase – stuitte de ontwikkelwerkgroep op enkele inhoudelijke hiaten en onvolledigheden. Dit noemen we hier ‘ontwikkellacunes’. Het gevolg van deze lacunes is dat sommige uitgangsvragen niet zo concreet te beantwoorden waren als wenselijk was. Daarnaast bleken er vraagstukken te zijn die beleidsmatig van aard waren en daarmee inhoudelijk buiten de richtlijn vielen, maar die wel verduidelijking vereisten. Deze duidelijkheid was nodig om de richtlijn goed te kunnen toepassen. 

Ontwikkellacunes

De ontwikkellacunes vallen grofweg in twee categorieën:

1. Een gebrek aan wetenschappelijk onderzoek of goed uitgewerkte theoretische kaders. Dit soort onderzoek en uitgebreidere theoretische kaders zouden nieuw licht kunnen werpen op de aanbevelingen.  
2. Een gebrek aan beleidsmatige overwegingen of aanpassingen. Zulke overwegingen en aanpassingen zijn nodig om het continuüm van onderwijs en zorg rond dyslexie meer helderheid en slagkracht te bieden. 

Hieronder staan de belangrijkste lacunes die de ontwikkelwerkgroep aantrof tijdens de ontwikkeling van de richtlijn.

Continuüm van onderwijs en zorg in het voortgezet onderwijs

In het basisonderwijs is het al gebruikelijk om met een continuüm van onderwijs en zorg te werken. Deze richt zich op de ondersteuning van kinderen met lees- en/of spellingproblemen. Voor het voortgezet onderwijs is er een soortgelijk continuüm (Dood et al., 2020). Dit richt zich echter op de ondersteuning van leerlingen die al de diagnose dyslexie hebben.

Het is wenselijk om het continuüm van onderwijs en zorg voor het voortgezet onderwijs verder uit te werken. Vragen hierbij zijn: 

• Hoe zou dit continuüm eruit kunnen zien als het qua functie gelijkgetrokken werd met het continuüm voor het basisonderwijs?
• Hoe zou ondersteuningsniveau 3 er dan uit moeten zien bij leerlingen met lees- en/of spellingproblemen in het voortgezet onderwijs? 

Volgens de huidige richtlijn ligt de nadruk van interventies in het voortgezet onderwijs vooral op leesvloeiendheid binnen een betekenisvolle context. Ook leesbegrip en leesstrategieën krijgen bij die interventies vaak aandacht. Het is belangrijk om concreet te beschrijven welke activiteiten, instructie en materialen hiervoor geschikt zijn. 

Dyslexie

Er is meer onderzoek nodig naar de prevalentie van comorbiditeit in Nederland: de mate waarin het voorkomt dat mensen – zeker kinderen – tegelijkertijd dyslexie en een of meerdere andere leer- of ontwikkelingsproblemen hebben.

Signalering en ondersteuning

Om de hulp te verbeteren aan leerlingen met lees- en spellingproblemen, is het nodig om meer inzicht te krijgen in hoe scholen ondersteuningsniveau 1, 2 en 3 inrichten en wat de effecten daarvan zijn. Daarnaast moet duidelijker worden welke rol het schoolteam speelt in het realiseren en onderhouden van een duurzame, integrale aanpak – oftewel: een aanpak op systeemniveau. In samenwerking met Dyslexie Centraal valt deze rol verder te verfijnen en concretiseren. Scholen moeten daarvoor concrete handvatten krijgen. 

Diagnostiek

Er is een tekort aan diagnostisch testmateriaal dat zowel gericht is op technisch lezen en basisspelling als adequaat genormeerd is voor jongeren van 14 jaar of ouder. Hier valt ook testmateriaal onder voor technisch lezen en basisspelling in vreemde talen. Het is belangrijk om dit tekort tegen te gaan – en dus om op korte termijn meer van dat soort testmateriaal en testnormen te ontwikkelen.

Behandeling en ondersteuning

Er zijn geen onderzoekspublicaties over de effecten van psycho-educatie binnen een dyslexiebehandeling. 

Er is nog maar weinig op wetenschappelijk onderzoek gebaseerde kennis over de effectiviteit van dyslexiebehandeling (interventies) op prosodie en de leesmotivatie.

Ouders van kinderen met dyslexie hebben behoefte aan betrouwbare informatie over de effectiviteit van Nederlandse dyslexiebehandelingen. Tot nog toe is hier maar zeer beperkt onderzoek naar gedaan. En de kwaliteit van het onderzoek dát er is geweest, varieert sterk. Het zou goed zijn als er meeronderzoek zou komen, bij voorkeur met een vergelijkbare onderzoeksopzet voor verschillende dyslexiebehandelingen.

Er zijn nog geen conclusies te trekken over de langetermijneffecten van Nederlandse dyslexiebehandelingen. Daarvoor is er nog onvoldoende onderzoek gedaan. De geringe resultaten lopen bovendien sterk uiteen. Zo is er nog onvoldoende bekend over de mate waarin kinderen na hun behandeling goed genoeg blijven presteren op lees- en spellingtaken. Ook is het onduidelijk in hoeverre individuele verschillen invloed hebben op de mate waarin het effect van de behandeling beklijft. Beklijft dit bijvoorbeeld beter als kinderen hun behandeling in de onderbouw afronden dan als ze dat in de bovenbouw doen? Ook is onbekend hoe lees- en spellingvaardigheden zich ontwikkelen in de puberteit.

Er is weinig literatuur over de rol van ouders als co-therapeut in de behandeling van dyslexie.

Er is nauwelijks wetenschappelijk onderzoek naar de effectiviteit van dyslexiebehandeling bij adolescenten. Wat Néderlandse adolescenten betreft ontbreekt dit onderzoek zelfs volledig. Er is meer inzicht nodig in de werkzame elementen van dyslexiebehandelingen voor deze doelgroep.

In de huidige richtlijn ontbreekt systematische aandacht voor de therapeutische relatie (‘bejegening’). Dit onderwerp komt slechts fragmentarisch aan bod. Het is wenselijk om in kaart te brengen hoe de therapeutische relatie in de dyslexiebehandeling is te integreren.

Meer- en anderstaligen

Er is nog geen eenduidig antwoord op de vraag na hoeveel onderwijsjaren in Nederland een leerling betrouwbaar op dyslexie te testen is. Dit hangt sterk af van de achtergrond en taalontwikkeling van het meer- of anderstalige kind – en er is ook op deze vlakken een grote variatie binnen de groep meer- en anderstaligen. Om die vraag te beantwoorden, kan het helpen om enkele scenario’s uit te werken. Vier voorbeelden: 

1. Kinderen die al vanaf groep 1 in Nederland naar school gaan.
2. Kinderen die vanaf groep 3 instromen en in het Nederlands leren lezen (dus niet in hun moedertaal).
3. Oudere leerlingen in het basisonderwijs.
4. Leerlingen in een Internationale Schakelklas (ISK). 

LOWAN ontwikkelt momenteel leerlijnen voor nieuwkomersonderwijs. Op basis hiervan is mogelijk te bepalen of een individueel kind significant afwijkt van de verwachte gemiddelde resultaten.

Beleidsmatige vraagstukken 

Protocol Dyslexie Diagnostiek en Behandeling 3.0

Dit protocol (Tijms et al, 2021) vormt volgens de Jeugdwet de leidraad voor de diagnostiek en behandeling van Ernstige Dyslexie. Het valt op dit moment buiten de richtlijn Dyslexie, maar sluit daar inhoudelijk wel volledig op aan. De beroepsverenigingen en het NKD willen op termijn de vakinhoudelijke onderdelen van het protocol onderbrengen in deze richtlijn – specifiek de onsli=derdelen over de diagnostiek en behandeling van Ernstige Dyslexie (dyslexiezorg vanuit de Jeugdwet). Als dat gebeurt, zijn deze onderdelen te autoriseren door de beroepsverenigingen en het NKS. Zo komen ze binnen de professionele standaard te vallen.

Dyslexieverklaring hbo en wo

Een dyslexieverklaring geeft leerlingen toegang tot speciale voorzieningen, zoals extra tijd bij eindexamens. Scholen zijn verplicht om belemmeringen weg te nemen die een leerling ondervindt door zijn handicap of chronische ziekte. Dit staat in de Wet gelijke behandeling op grond van handicap of chronische ziekte. 
Wat voor leerlingen in het primair en voortgezet onderwijs geldt, geldt ook voor studenten in het hoger beroepsonderwijs (hbo) en wetenschappelijk onderwijs (wo): alleen als zij een dyslexieverklaring kunnen laten zien, krijgen zij voorzieningen toegekend die bedoeld zijn om hun belemmeringen te verkleinen. 
De vraag is of er meer te doen is om belemmerende factoren weg te nemen en beschermende factoren te versterken. Dat zou de handelingsgerichtheid vergroten: de mate waarin dyslexiegerelateerde problemen van studenten praktisch, doelgericht en duurzaam effectief op te lossen zijn. Wat is er kortom nodig om die handelingsgerichtheid te vergroten?

Inzet professionals 

De richtlijn Dyslexie behandelt de de rol van verschillende soort zorg- en onderwijsprofessionals in de ondersteuning van leerlingen met dyslexie. Het is belangrijk om hun taken per ondersteuningsniveau concreet te maken, inclusief de benodigde opleiding, specialisatie, ervaring en registratie. Daarbij moet er specifiek aandacht zijn voor de vraag hoe de inzet van professionals eruit moet zien bij ondersteuningsniveau 3, bij behandeling, bij nazorg en bij de actualisatie van de dyslexieverklaring:

• Inzet bij ondersteuningsniveau 3: In de praktijk voeren professionals uit diverse beroepsgroepen ondersteuning op niveau 3 uit: logopedisten, intern begeleiders (IB’ers), remedial teachers (RT’ers), leerkrachten em onderwijsassistenten. De vraag is welke beroepsgroepen het best zijn toegerust voor de specifieke taken die nodig zijn op dit ondersteuningsniveau, zoals planvorming, ondersteuning op maat en de uitvoering van gestandaardiseerde activiteiten binnen een ondersteuningsprogramma.
• Inzet bij behandeling: Gedragswetenschappers en logopedisten die gespecialiseerd zijn in dyslexie (‘dyslexiebehandelaars’) voeren de dyslexiebehanddeling uit. Logopedisten werken hierbij onder de verantwoordelijkheid van een regiebehandelaar. Er is discussie over de vraag of dyslexiespecialisten met een registratrie bij de Landelijke Beroepsvereniging Remedial Teachers (LBRT) ook een rol moeten krijgen in de behandeling van dyslexie – en zo ja: welke rol dan.
• Inzet bij nazorg: Nazorg en interventies bij terugval vinden meestal plaats in de schoolomgeving. Het is nodig om hierbij professionals uit diverse beroepsgroepen te betrekken. Het is echter nog niet helder welke beroepsgroepen precies – en welke taken onder welke beroepsgroep vallen.
• Inzet bij actualisering dyslexieverklaring: In de richtlijn staat dat lees- en spellingspecialisten bijdragen aan de actualisering van de dyslexieverklaring. Deze actualisering vereist specifieke deskundigheid. De vraag is lees- en spellingspecialisten ondersteuning moeten krijgen bij dat proces – en bij de formulering van adequate handelingsadviezen. Het is nodig om hier heldere afspraken over te maken.  

Na de vaststelling en autorisatie van de richtlijn is het belangrijk om samen met de betrokken beroepsgroepen te bepalen welke professionals betrokken zijn bij de dyslexieondersteuning. Daarbij moet rekening gehouden worden met drie zaken:

1. De financiering.
2. Het Kwaliteitskader voor verantwoorde werktoedeling.
3. De bevoegdheden en bekwaamheden die professionals nodig hebben.  

Nazorg

Nazorg is zeer gewenst, net als interventie bij terugval. Maar beide worden vaak belemmerd door discussie over de financiering. Het is belangrijk om duidelijk te hebben wie financieel verantwoordelijk is voor de extra ondersteuning na de behandeling.

De werkgroep Beheer Brede Vakinhoudelijke Richtlijn Dyslexie brengt jaarlijks toelichtingen uit die ingaan op vraagstukken naar aanleiding van de richtlijn. Lees hier de toelichtingen:

Toelichting 1
Toelichting 2

Aanvullende vraagstukken met betrekking tot de richtlijn kan je inbrengen bij de werkgroep via info@bvrdbeheer.nl.

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