Recognizing Psychiatric Comorbidity With Reading Disorders

Sequential and spatial letter reversals in adults with dyslexia during a word comparison task: demystifying the "was saw" and "db" myths

Whether sequential and spatial letter reversals characterize dyslexia in children has been unclear, largely due to developmental variability of these errors in children with and without dyslexia. Here we demonstrate both types of reversals for the first time in adults with dyslexia (n = 22) but not in control adults (n = 20). Participants evaluated 576 word pairs that consisted of two identical words or two words that differed subtly, by categorizing them as same or different. Two subsets of word pairs differed in sequential (e.g. "two tow") and spatial (e.g. "cob cod") letter reversals. The adults with dyslexia were less accurate than the controls regarding both types of word pairs. Their accuracy during left/right letter reversals was lower, compared to both up/down letter reversals (e.g. "cub cup") and nonsymmetric letter similarities (e.g. "half halt"). Accuracy during left/right reversals was correlated with accuracy during sequential rearrangement in the word pair task as well as with a composite measure of sequential processing based on nonword repetition, nonword reading, and multisyllabic word repetition. It was also correlated with a composite measure of literacy skills. A subset of the dyslexia group who produced left/right errors during a rapid single letter naming task obtained lower accuracy than the dyslexia subgroup without such errors during both types of letter reversals, and their overall literacy skills were lower. We conclude that sequential and left/right letter reversals characterize a severe dyslexia subtype. These two types of reversal are associated, are part of a general deficit in sequential processing likely due to cerebellar deficits, and persist into adulthood.

Spelling errors reveal underlying sequential and spatial processing deficits in adults with dyslexia

Recent studies showed that some adults with dyslexia have difficulty processing sequentially arranged information. In a companion study, this deficit manifested as low accuracy during a word pair comparison task involving same/different decisions when two words differed in their letter sequences. This sequential deficit was associated with left/right spatial letter confusion. In the present study, we found the same underlying difficulty with sequential and spatial letter processing during word spelling. Participants were the same 22 adults with dyslexia and 20 age- and gender-matched controls as in the companion study. In the spelling task, sequential error rates were higher in the dyslexia group, compared to the controls. Measures of accuracy of serial letter order during the spelling task and the word comparison task were correlated. Only three participants, each with dyslexia, produced left/right letter reversals during spelling. These were the same participants who produced left/right errors when naming single letters. They also had profound difficulty with sequential and left/right letter processing in the spelling and word comparison tasks, and they had the most severe spelling impairment. We conclude that this pervasive, persistent difficulty with sequential and spatial reversals contributes to a severe dyslexia subtype. In the dyslexia group as a whole, additional and separate sources of errors were underspecified word representations in long-term memory and homophone errors that likely represent language-based deficits in word knowledge. In the participants, these three factors (sequential/spatial letter confusion, underspecified word form representation, language-based deficits) occurred either as single factors or in combination with each other.

Development and feasibility analysis of an assistance system for high school students with dyslexia

BACKGROUND

Students with dyslexia may be at a disadvantage on timed assessments that require reading skills compared to their non-dyslexic peers, even though they are not necessarily less intelligent or less prepared than these students.

AIMS

The study aims to analyze the possible benefits in reading comprehension and reading fluency of students with Dyslexia when using an assistance tool in an evaluation that requires reading skills.

METHODS AND PROCEDURES

Each participant with dyslexia did a reading comprehension assessment in two different reading interfaces: on a white paper and in our previously developed tool, in order to assess and compare their reading comprehension and reading fluency.

OUTCOMES AND RESULTS

The results obtained show that students with dyslexia could benefit from the point of view of fluency and reading comprehension by using compensation software that helps them read in situations of anxiety.

CONCLUSIONS AND IMPLICATIONS

Properly designed assistive tools can enhance the reading skills of young people with dyslexia. The developed tool should be improved considering the improvements proposed in the present studies, in the same way it is suggested to carry out a study with a larger number of participants and evaluate them individually.

Effects of a short, intensive, multi-session tDCS treatment in developmental dyslexia: Preliminary results of a sham-controlled randomized clinical trial

Developmental Dyslexia (DD) significantly interferes with academic, personal, social and emotional functioning. Nevertheless, established therapeutic options are still scarce. Research has begun to emerge studying the potential action of transcranial direct current stimulation (tDCS) for ameliorating reading. However, there are still open questions regarding the most suitable tDCS protocol in young with DD. The current study tested the effectiveness of a short, intensive and multi-session tDCS protocol and presented preliminary data from a randomized sham-controlled crossover trial. Twenty-seven children and adolescents with DD were randomly assigned to active tDCS or sham tDCS. Active tDCS group received five daily-consecutive sessions of left anodal/right cathodal set at 1mA for 20min over parieto-occipital regions. Reading measures, including text, high frequency word, low frequency word and non-word lists, were recorded before, immediately after the treatment and 1-week later. We found that only the active tDCS group ameliorated non-word reading speed immediately after and 1-week later the end of the treatment compared to the baseline. Some suggestions for the development of future tDCS protocols in children and adolescents with DD are given.

Early screening of reading and writing difficulties in the first grade - a pilot study

ABSTRACT Purpose: to investigate the effectiveness of an early identification screening based on the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) test, 6th edition, to early identify first graders at risk of dyslexia. Methods: the sample comprised 34 children assessed at two moments - the screening was conducted while they were in the first grade, while a word dictation was used when they were in the second grade. The data were analyzed with Pearson’s correlation test, linear regression analysis, and ANOVA, with a p-value ≤ 0.05. Results: the results provide evidence that agrees with other studies in that children with signs of risk of dyslexia differ from children with typical development in terms of less phonological skills and that these differences are already present at the beginning of the literacy process. Conclusion: the early screening allows for the identification of the risk factors for dyslexia, making it possible to implement preventive and personalized phonological skills training to make the literacy process easier.

Enhanced visceromotor emotional reactivity in dyslexia and its relation to salience network connectivity

Dyslexia is a neurodevelopmental disorder mainly defined by reading difficulties. During reading, individuals with dyslexia exhibit hypoactivity in left-lateralized language systems. Lower activity in one brain circuit can be accompanied by greater activity in another, and, here, we examined whether right-hemisphere-based emotional reactivity may be elevated in dyslexia. We measured emotional reactivity (i.e., facial behavior, physiological activity, and subjective experience) in 54 children ages 7-12 with (n = 32) and without (n = 22) dyslexia while they viewed emotion-inducing film clips. Participants also underwent task-free functional magnetic resonance imaging. Parents of children with dyslexia completed the Behavior Assessment System for Children, which assesses real-world behavior. During film viewing, children with dyslexia exhibited significantly greater reactivity in emotional facial behavior, skin conductance level, and respiration rate than those without dyslexia. Across the sample, greater emotional facial behavior correlated with stronger connectivity between right ventral anterior insula and right pregenual anterior cingulate cortex (pFWE<.05), key salience network hubs. In children with dyslexia, greater emotional facial behavior related to better real-world social skills and higher anxiety and depression. Our findings suggest there is heightened visceromotor emotional reactivity in dyslexia, which may lead to interpersonal strengths as well as affective vulnerabilities.

Neurodiversity at work: a biopsychosocial model and the impact on working adults

INTRODUCTION

The term neurodiversity is defined and discussed from the perspectives of neuroscience, psychology and campaigners with lived experience, illustrating the development of aetiological theories for included neurodevelopmental disorders. The emerging discourse is discussed with relevance to adults, social inclusion, occupational performance and the legislative obligations of organizations.

SOURCES OF DATA

Literature is reviewed from medicine, psychiatry, psychology, sociology and popular press. No new data are presented in this article.

AREAS OF AGREEMENT

There is consensus regarding some neurodevelopmental conditions being classed as neurominorities, with a 'spiky profile' of executive functions difficulties juxtaposed against neurocognitive strengths as a defining characteristic.

AREAS OF CONTROVERSY

The developing nomenclature is debated and the application of disability status versus naturally occurring difference. Diagnosis and legal protections vary geographically, resulting in heretofore unclear guidance for practitioners and employers.

GROWING POINTS

The evolutionary critique of the medical model, recognizing and updating clinical approaches considering the emerging consensus and paradigmatic shift.

AREAS TIMELY FOR DEVELOPING RESEARCH

It is recommended that research addresses more functional, occupational concerns and includes the experiences of stakeholders in research development, moving away from diagnosis and deficit towards multi-disciplinary collaboration within a biopsychosocial model.

The prevalence and comorbidity rates of specific learning disorder among primary school children in Turkey

Purpose: The aim of the present study was to investigate the prevalence of specific learning disorder (SLD), comorbid disorders, and risk factors in primary school children for the first time in two-stage design in Turkey.Materials and methods: Participants were 1041 pupils in 28 primary schools and aged from 7 to 11. The Mathematics, Reading, Writing Assessment Scale (MOYA) teacher and parent forms were used in the screening stage and parents and teachers of each child completed MOYA. Ninety-five children were screen positive and eighty-three of these children participated in the interview. SLD diagnoses were based on DSM V criteria. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used for the comorbid psychiatric disorders.Results and conclusions: The prevalence rate of the SLD was 6.6%, impairment in reading was 4%, in mathematics was 3.6%, and in written expression was 1.8%. About 62.75% of children with SLD had one or more comorbid diagnoses. ADHD was the most common comorbid mental disorder in SLD (54.9%). SLD prevalence was higher among males. The prevalence of SLD in primary school children in Turkey is consistent with previous studies.

Anxiety and Attentional Bias in Children with Specific Learning Disorders

Children with specific learning disorders (SLDs) face a unique set of socio-emotional challenges as a result of their academic difficulties. Although a higher prevalence of anxiety in children with SLD is often reported, there is currently no research on cognitive mechanisms underlying this anxiety. One way to elucidate these mechanisms is to investigate attentional bias to threatening stimuli using a dot-probe paradigm. Our study compared children ages 9-16 with SLD (n = 48) to typically-developing (TD) controls (n = 33) on their attentional biases to stimuli related to general threats, reading, and stereotypes of SLD. We found a significant threat bias away from reading-related stimuli in the SLD, but not TD group. This attentional bias was not observed with the general threat and stereotype stimuli. Further, children with SLD reported greater anxiety compared to TD children. These results suggest that children with SLD experience greater anxiety, which may partially stem from reading specifically. The finding of avoidance rather than vigilance to reading stimuli indicates the use of more top-down attentional control. This work has important implications for therapeutic approaches to anxiety in children with SLD and highlights the need for attention to socio-emotional difficulties in this population. Future research is needed to further investigate the cognitive aspects of socio-emotional difficulties in children with SLD, as well as how this may impact academic outcomes.

Reintroducing Dyslexia: Early Identification and Implications for Pediatric Practice

Dyslexia is a common learning disorder that renders children susceptible to poor health outcomes and many elements of socioeconomic difficulty. It is commonly undiagnosed until a child has repeatedly failed to learn to read in elementary school; this late diagnosis not only places the child at an academic disadvantage but also can be a precursor to psychiatric comorbidities such as anxiety and depression. Genetic and neuroimaging research have revealed that dyslexia is heritable and that it is undergirded by brain differences that are present even before reading instruction begins. Cognitive-behavioral research has revealed that there are early literacy skill deficits that represent red flags for dyslexia risk and can be measured at a preschool age. Altogether, this evidence points to dyslexia as a disorder that can be flagged by a pediatrician before school entry, during a period of heightened brain plasticity when interventions are more likely to be effective. In this review, we discuss the clinical implications of the most recent advances in dyslexia research, which converge to indicate that early identification and screening are crucial to the prevention or mitigation of adverse secondary consequences of dyslexia. We further highlight evidence-based and practical strategies for the implementation of early risk identification in pediatric practice so that physicians can be empowered in their ability to treat, educate, and advocate for their patients and families with dyslexia.

Unisensory and multisensory temporal processing in autism and dyslexia: A systematic review and meta-analysis

This study presents a comprehensive systematic review and meta-analysis of temporal processing in autism spectrum disorder (ASD) and developmental dyslexia (DD), two neurodevelopmental disorders in which temporal processing deficits have been highly researched. The results provide strong evidence for impairments in temporal processing in both ASD (g = 0.48) and DD (g = 0.82), as measured by judgments of temporal order and simultaneity. In individual analyses, multisensory temporal processing was impaired for both ASD and DD, and unisensory auditory, visual and tactile processing were all impaired in DD. In ASD, speech stimuli showed moderate impairment effect sizes, whereas nonspeech stimuli showed small effects. Greater reading and spelling skills in DD were associated with greater temporal precision. Temporal deficits did not show changes with age in either disorder. In addition to more clearly defining temporal impairments in ASD and DD, the results highlight common and distinct patterns of temporal processing between these disorders. Deficits are discussed in relation to existing theoretical models, and recommendations are made for future research.

Behavior Problems and Depressive Symptoms in Developmental Dyslexia: Risk Assessment in Brazilian Students

Objective

To investigate if students with developmental dyslexia (DD) have more behavior problems and depressive symptoms than students without learning difficulties.

Method

Participants were 61 students, aged 7-14 years, including 31 with interdisciplinary DD diagnosis and 30 without learning disabilities. We collected data from parents, using the children’s behavior checklist (CBCL), and from students, using the children’s depression inventory (CDI).

Results

The DD group had higher CBCL averages for anxiety, depression, withdrawal, rule-breaking behaviors, aggressiveness, and social, attentional and thought problems. They also showed higher results for the internalizing and externalizing categories, others and total. In the CDI, DD students had higher averages for total score and for the following symptoms: negative self-evaluation, guilt, suicidal thoughts, feeling concern, performance comparison, sleeping difficulties, fatigue, and problems in interacting with peers at school.

Conclusions

We discuss the results in terms of implications for DD diagnosis and intervention. Parent reports indicate a higher frequency of behavior problems in students with DD diagnosis. Those students also demonstrate more symptoms of depression than students without learning difficulties.

Comorbidities Between Specific Learning Disorders and Psychopathology in Elementary School Children in Germany

Children with reading and/or spelling disorders have increased rates of behavioral and emotional problems and combinations of these. Some studies also find increased rates of attention-deficit/hyperactivity disorder (ADHD), conduct disorder, anxiety disorder, and depression. However, the comorbidities of, e.g., arithmetic disorders with ADHD, anxiety disorder, and depression have been addressed only rarely. The current study explored the probability of children with specific learning disorders (SLD) in reading, spelling, and/or arithmetic to also have anxiety disorder, depression, ADHD, and/or conduct disorder. The sample consisted of 3,014 German children from grades 3 and 4 (mean age 9;9 years) who completed tests assessing reading, spelling as well as arithmetic achievement and intelligence via a web-based application. Psychopathology was assessed using questionnaires filled in by the parents. In children with a SLD we found high rates of anxiety disorder (21%), depression (28%), ADHD (28%), and conduct disorder (22%). Children with SLD in multiple learning domains had a higher risk for psychopathology and had a broader spectrum of psychopathology than children with an isolated SLD. The results highlight the importance of screening for and diagnosing psychiatric comorbidities in children with SLD.

An Epidemiological Study of Chinese Children with Developmental Dyslexia

OBJECTIVE

The epidemiological studies of Chinese developmental dyslexia (DD) in China are still limited. The current study aimed to investigate the prevalence rate, risk factors, and psychiatric comorbidities of Chinese DD in Guangzhou, a city in South China.

METHOD

A total of 1661 students from second to fifth grades were recruited. The dyslexic students were identified by evaluating learning disability through the Pupil Rating Scale-Revised Screening for Learning Disability (PRS) scale by the head teachers and word recognition through the standard test. Students with a PRS score of <65 received the Raven's test, and those with intelligence quotient scores below 80 in the Raven's test were excluded. Psychiatric comorbidities were assessed by the Strength and Difficulties Questionnaire completed by parents.

RESULTS

The prevalence rate of Chinese DD was 4.9% in Guangzhou city. There were significant differences in gender, the paternal educational level, and reading experience before the age of 6 years between the DD group and the non-DD group. Male gender (odds ratio [OR] = 4.17), low paternal educational level (p = 0.045), and lack of reading experience before the age of 6 years (OR = 1.99) were the risk factors for DD. The DD cases had a higher risk of hyperactivity and inattention (OR = 3.21).

CONCLUSION

This study showed that the prevalence rate of DD was 4.9% in Guangzhou city. Male gender, low paternal educational level, and lack of reading experience before the age of 6 years were the risk factors for Chinese DD. The high comorbidity rate of hyperactivity and inattention in the Chinese DD population needs further evaluation.

Genome-wide association study of word reading: Overlap with risk genes for neurodevelopmental disorders

Reading disabilities (RD) are the most common neurocognitive disorder, affecting 5% to 17% of children in North America. These children often have comorbid neurodevelopmental/psychiatric disorders, such as attention deficit/hyperactivity disorder (ADHD). The genetics of RD and their overlap with other disorders is incompletely understood. To contribute to this, we performed a genome-wide association study (GWAS) for word reading. Then, using summary statistics from neurodevelopmental/psychiatric disorders, we computed polygenic risk scores (PRS) and used them to predict reading ability in our samples. This enabled us to test the shared aetiology between RD and other disorders. The GWAS consisted of 5.3 million single nucleotide polymorphisms (SNPs) and two samples; a family-based sample recruited for reading difficulties in Toronto (n = 624) and a population-based sample recruited in Philadelphia [Philadelphia Neurodevelopmental Cohort (PNC)] (n = 4430). The Toronto sample SNP-based analysis identified suggestive SNPs (P ~ 5 × 10^-7 ) in the ARHGAP23 gene, which is implicated in neuronal migration/axon pathfinding. The PNC gene-based analysis identified significant associations (P < 2.72 × 10^-6 ) for LINC00935 and CCNT1, located in the region of the KANSL2/CCNT1/LINC00935/SNORA2B/SNORA34/MIR4701/ADCY6 genes on chromosome 12q, with near significant SNP-based analysis. PRS identified significant overlap between word reading and intelligence (R²  = 0.18, P = 7.25  × 10^-181 ), word reading and educational attainment (R²  = 0.07, P = 4.91 × 10^-48 ) and word reading and ADHD (R²  = 0.02, P = 8.70 × 10^-6 ; threshold for significance = 7.14 × 10^-3 ). Overlap was also found between RD and autism spectrum disorder (ASD) as top-ranked genes were previously implicated in autism by rare and copy number variant analyses. These findings support shared risk between word reading, cognitive measures, educational outcomes and neurodevelopmental disorders, including ASD.

Dyslexia: neurobiology, clinical features, evaluation and management

Neurobiology helps us understand the processes that drive neurological processes including dyslexia. This article outlines the neurobiology underpinning typical reading skills and those seen in dyslexia, which is characterized by problems with accurate or fluent word recognition, poor decoding, and poor spelling abilities. There are exciting new developments in the neurobiological changes resulting from educational interventions for dyslexia, though more research is needed in this regard. This article also outlines the clinical features of dyslexia across the developmental span, and provides guidance to clinicians about referral to community resources and advocacy for families to seek educational interventions. Screening and diagnostic tools are described, as are interventions for remediation and accommodations for dyslexia across the educational span.

Two Autism/Dyslexia Linked Variations of DOCK4 Disrupt the Gene Function on Rac1/Rap1 Activation, Neurite Outgrowth, and Synapse Development

Autism spectrum disorder (ASD) and dyslexia are both neurodevelopmental disorders with high prevalence in children. Both disorders have strong genetic basis, and share similar social communication deficits co-occurring with impairments of reading or language. However, whether these two disorders share common genetic risks remain elusive. DOCK4 (dedicator for cytokinesis 4), a guanine nucleotide exchange factor (GEF) for the small GTPase Rac1, is one of few genes that are associated with both ASD and dyslexia. Dock4 is important for neuronal development and social behaviors. Two DOCK4 variations, Exon27-52 deletion (protein product: Dock4-945VS) and a missense mutation at rs2074130 (protein product: Dock4-R853H), are associated with dyslexia and/or ASD with reading difficulties. The present study explores the molecular and cellular functions of these two DOCK4 variants on neuronal development, by comparing them with the wild-type Dock4 protein. Notably, it is revealed that both mutants of Dock4 showed decreased ability to activate not only Rac1, but also another small GTPase Rap1. Consistently, both mutants were dysfunctional for regulation of cell morphology and cytoskeleton. Using Neuro-2a cells and hippocampus neurons as models, we found that both mutants had compromised function in promoting neurite outgrowth and dendritic spine formation. Electrophysiological recordings further showed that R853H partially lost the ability to promote excitatory synaptic transmission, whereas 945VS totally lost the ability. Together, we identified R853 as a previously uncharacterized site for the regulation of the integrity of Dock4 function, and provides insights in understanding the common molecular pathophysiology of ASD and dyslexia.

Impact of mentoring on socio-emotional and mental health outcomes of youth with learning disabilities and attention-deficit hyperactivity disorder

BACKGROUND

Learning disabilities (LD) and attention-deficit hyperactivity disorder (ADHD) are often accompanied by significant socio-emotional impairments and mental health challenges. However, there is a lack of controlled, quantitative research on potential interventions to address this issue. The current study evaluated the impact of a near-peer mentoring program for youth with LD/ADHD designed to promote socio-emotional well-being.

METHODS

Youth with LD/ADHD who participated in the mentoring program (Mentored; n=99) were compared to non-mentored youth with LD/ADHD (Control-NM; n=51) and typically-developing youth without LD/ADHD (Control-TD; n=81) pre-mentoring in the fall, and post-mentoring in the spring. Participants were assessed on self-report measures of anxiety, depression, interpersonal relations, and self-esteem.

RESULTS

Youth with LD/ADHD showed significantly higher scores of depression and significantly lower scores of interpersonal relations compared to the Control-TD group at fall baseline. The depression and self-esteem scores of the Mentored group significantly decreased and increased respectively after mentoring. These changes were associated with mentee-perceived mentorship quality. The Control-NM group showed significant decreases in both self-esteem and interpersonal relations, as well as increases in depression over time, while the Control-TD group remained stable across all measures.

CONCLUSIONS

Results suggest that mentoring shows promise as a potential intervention for youth with LD/ADHD and co-occurring socio-emotional and mental health difficulties. The study is the first, to our knowledge, to quantify the effect of a near-peer mentoring program on youth with LD/ADHD in a design with two control groups. Implications for research and practice involving LD, ADHD, and mental health disorders are discussed.

Mild-to-Moderate Gestational Iodine Deficiency Processing Disorder

This synopsis paper aims to identify if a common pattern of learning and social difficulties can be conceptualized across recent longitudinal studies investigating the influence of mild-to-moderate gestational iodine deficiency (GID) on offspring's optimal cognitive and psycho-social development. The main studies investigated are: The Southampton Women's Study (SWS)-United Kingdom; the Avon Longitudinal Study of Parents and Children (ALSPAC)-United Kingdom; the Gestational Iodine Cohort Longitudinal Study-Tasmania, Australia, and the Danish National Birth Cohort Case-Control Study-Denmark. In contrast to severe GID where there is a global negative impact on neurodevelopment, mild-to-moderate intrauterine iodine deficiency has subtler, but nonetheless important, permanent cognitive and psycho-social consequences on the offspring. This paper links the results from each study and maintains that mild-to-moderate GID is associated with a disorder that is characterized by speed of neural transmitting difficulties that are typically associated with working memory capacity difficulties and attention and response inhibition. The authors maintain that this disorder is better identified as Gestational Iodine Deficiency Processing Disorder (GIDPD), rather than, what to date has often been identified as 'suboptimal development'. The Autistic Spectrum Disorder (ASD), Attention Deficit, Hyperactivity Disorder (ADHD), language and literacy disorders (learning disabilities and dyslexia) are the main manifestations associated with GIDPD. GIDPD is identified on IQ measures, but selectively and mainly on verbal reasoning IQ subtests, with individuals with GIDPD still operating within the 'normal' full-scale IQ range. Greater consideration needs to be given by public health professionals, policy makers and educators about the important and preventable consequences of GID. Specifically, more emphasis should be placed on adequate iodine intake in women prior to pregnancy, as well as during pregnancy and when lactating. Secondly, researchers and others need to further extend, refine and clarify whether GIDPD, as a nosological (medical classification) entity, is a valid disorder and concept for consideration.

Brain activity patterns of phonemic representations are atypical in beginning readers with family risk for dyslexia

There is an ongoing debate whether phonological deficits in dyslexics should be attributed to (a) less specified representations of speech sounds, like suggested by studies in young children with a familial risk for dyslexia, or (b) to an impaired access to these phonemic representations, as suggested by studies in adults with dyslexia. These conflicting findings are rooted in between study differences in sample characteristics and/or testing techniques. The current study uses the same multivariate functional MRI (fMRI) approach as previously used in adults with dyslexia to investigate phonemic representations in 30 beginning readers with a familial risk and 24 beginning readers without a familial risk of dyslexia, of whom 20 were later retrospectively classified as dyslexic. Based on fMRI response patterns evoked by listening to different utterances of /bA/ and /dA/ sounds, multivoxel analyses indicate that the underlying activation patterns of the two phonemes were distinct in children with a low family risk but not in children with high family risk. However, no group differences were observed between children that were later classified as typical versus dyslexic readers, regardless of their family risk status, indicating that poor phonemic representations constitute a risk for dyslexia but are not sufficient to result in reading problems. We hypothesize that poor phonemic representations are trait (family risk) and not state (dyslexia) dependent, and that representational deficits only lead to reading difficulties when they are present in conjunction with other neuroanatomical or-functional deficits.

Pediatric Referrals for Urgent Psychiatric Consultation: Clinical Characteristics, Diagnoses and Outcome of 4 to 12 Year Old Children

OBJECTIVES

1) To describe clinical characteristics and outcomes of children referred for urgent psychiatric consultation to a Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC); and, 2) To study the association between referral source, clinical characteristics, and post assessment outcome.

METHOD

This is a 12-month retrospective cohort study of children aged 4 to 12-years referred to a CAMHUCC. The clinic's electronic data base contains demographic and clinical information including reason for referral, diagnosis, and consult outcome. Study data were extracted and analyzed using descriptive statistics and Mann-Whitney U tests.

RESULTS

The study sample consisted of 120 children, 41.5% male, average age 9.03 years (SD=2.2). Fifty-percent were referred by Children's Mental Health Agencies (CMHA) and 31.7% by Emergency Departments. The most frequent reason for referral was aggression (64.1%). Most common diagnoses were externalizing disorders (76.7%). Thirty-percent had an identified learning disorder, 80% were referred back to the community and 14.2% were referred to outpatient clinic. There was a significant association between referral from an Emergency Department and female gender (p=0.048) and brief follow-up with CAMHUCC (p=0.006).

CONCLUSION

Regardless of source of referral, the most common reason for urgent psychiatric referral was aggression and the majority of individuals did not require inpatient psychiatric care. Collaborative multiagency education in child and adolescent mental health disorders, including the role of learning disabilities in externalizing behaviors, may improve the capacity of CMHA and schools to identify and provide focused interventions that may, in turn, reduce behavioral crisis and visits to Emergency Departments and urgent clinics.

Dyslexia as a Neurodevelopmental Disorder and What Makes It Different from a Chess Disorder

The convenience of referring to dyslexia as a neurodevelopmental disorder has been repeatedly brought into question. In this opinion article, we argue in favor of the current diagnosis of dyslexia based on the criteria of harm and dysfunction. We discuss the favorable clinical and educational outcomes of a neuroscience-informed approach of dyslexia as a disorder. Furthermore, we discuss insights derived from neuroimaging studies and their importance to address problems related to developmental dyslexia.

Specific learning disability

Specific learning disabilities (SLD) have an impact on discrete areas of academic function. They result in a level of difficulty that is unexpected when considered in the context of a student's overall intellectual and academic competence. A common example is dyslexia, an SLD that affects the acquisition of literacy. Medical professionals have an important role to play in the evaluation and management of SLD. The medical role is founded on the fact that these conditions are biologically based and have the potential to cause significant harm for the developing child. Even if details of biological causation are not possible to demonstrate for individual children, medical professionals may, nevertheless, make an important judgement call regarding the likelihood of aetiology. When learning problems are medically based, it is clearly unreasonable to expect children to do more than they are able and to learn faster than is reasonable. Advocacy around these biological presumptions and their implications is a major contribution to the well-being of children who have SLD.

COGNITIVE MODIFICATION IN STUDENTS WITH READING PROBLEMS AND ADHD-CT

In this exploratory study, the PASS Reading Enhancement Program (PREP) was implemented individually as a cognitive modification program on five Puerto Rican children between 7 and 9 years old with reading difficulties and Attention Deficit Disorder and Hyperactivity - Combined Type. The PREP is based on the Planning, Attention, Simultaneous and Successive processing (PASS) theory and its purpose is to improve reading achievement. Results suggest that cognitive modification was possible, even in children with attention and hyperactivity problems. There was improvement in successive processing, and its relationship with decoding skills was evidenced. The PREP also contributed to optimize children's performance in comprehension skills. The results of this study may improve the academic performance of students with these or similar characteristics and increase their overall academic achievement. This in turn may contribute to advance collaboration between researchers and educators to reduce the gap between scientific research and educational practices.