The multiple deficit model of dyslexia: what does it mean for identification and intervention?

Dyslexia in the twenty-first century: a commentary on the IDA definition of dyslexia

In offering a commentary upon the IDA definition, we address its main components in turn. While each is technically accurate, we argue that, when taken together, the definition, or more accurately, the use to which it is often put, becomes problematic. We outline different current conceptions of dyslexia and conclude that the operationalisation of the definition for diagnostic purposes often results in scientifically questionable diagnoses and inadvertently leads to significant educational inequity. We propose a simpler definition that describes the primary difficulty, avoids reference to causal explanation, unexpectedness, and secondary outcomes, and redirects practitioner and policymaker focus to the importance of addressing and meeting the needs of all struggling readers.

The Contribution of Perceptual Reasoning Skills to Phonological Awareness for School Age Autistic Children

This study aimed to investigate the phonological awareness (PA) skills of school age autistic children (age range = 6-12) in two parts: (1) comparing their performance on a PA task to non-autistic children with groups matched on chronological age, verbal and non-verbal cognitive skills, and (2) exploring the role of cognitive skills and autism characteristics on PA skills. Results revealed that the groups did not differ in their PA skills (study 1) and that perceptual reasoning skills are associated with the PA skills of autistic participants (study 2). Results highlight the role of non-verbal cognitive skills in literacy development for autistic children and suggest that their perceptual reasoning abilities likely contribute a great deal when learning to read.

The challenge of remote treatment in neuropsychological intervention for reading and spelling in dyslexia: A prospective observational cohort study

Telemedicine approaches have proved to be valuable solutions for the delivery of treatment for many health-related issues, and crucial during the pandemics. Nonetheless, the efficacy of such Web-based practices in developmental dyslexia needs to be thoroughly evaluated. To this aim, the effects of a multi-componential program for neuropsychological intervention in dyslexia delivered as an outpatient program were compared with those obtained with a remotely delivered, Web-based treatment, based on the same methodological principles and delivered with the same duration and intensity. The treatment-related changes obtained with a combination of visual hemisphere-specific stimulation and training of visual-spatial attention through action video games, were compared to those obtained through remote treatment via the Tachidino Web-based platform. Both treatments had a duration of 4 weeks. The same battery of reading and phonemic awareness tests was delivered in presence, before and after treatment, as well as at 6-months follow-up. User satisfaction was assessed through parents and user questionnaires. Both treatments were significantly and similarly effective in improving reading speed, reading accuracy, and writing accuracy. No reduction in the effects was observed after treatment discontinuation. The Web-based treatment may thus offer a valid alternative to in-person intervention, optimizing the flexibility, capillary diffusion and cost-effectiveness of intervention.

Remote treatment of developmental dyslexia: how ADHD comorbidity, clinical history and treatment repetition may affect its efficacy

Introduction

Tachidino is a web-based platform for remote treatment of reading and spelling disorders. The purpose of the present study was to investigate the possible impact of different clinical conditions on the efficacy of treatment. The focus was on possible ADHD comorbidity-related effects on the outcomes of the Tachidino treatment, and the impact of previous treatments, such as speech and language therapy or the repetition of the same Tachidino program.

Methods

136 children with developmental dyslexia received four-weeks treatment via the Tachidino platform. Improvements in reading and writing scores were compared between different subgroups.

Results

No gross differences emerged in treatment effectiveness between groups of children. Children receiving treatment improved significantly more than untreated children.

Discussion

Treatment with Tachidino brought significant benefits for all children, irrespective of comorbidity, clinical history or treatment repetition. Comparison with an untreated control group (waiting list) made it possible to exclude that improvement was due to test-retest learning effects.

The ReadFree tool for the identification of poor readers: a validation study based on a machine learning approach in monolingual and minority-language children

In this study, we validated the "ReadFree tool", a computerised battery of 12 visual and auditory tasks developed to identify poor readers also in minority-language children (MLC). We tested the task-specific discriminant power on 142 Italian-monolingual participants (8-13 years old) divided into monolingual poor readers (N = 37) and good readers (N = 105) according to standardised Italian reading tests. The performances at the discriminant tasks of the "ReadFree tool" were entered into a classification and regression tree (CART) model to identify monolingual poor and good readers. The set of classification rules extracted from the CART model were applied to the MLC's performance and the ensuing classification was compared to the one based on standardised Italian reading tests. According to the CART model, auditory go-no/go (regular), RAN and Entrainment100bpm were the most discriminant tasks. When compared with the clinical classification, the CART model accuracy was 86% for the monolinguals and 76% for the MLC. Executive functions and timing skills turned out to have a relevant role in reading. Results of the CART model on MLC support the idea that ad hoc standardised tasks that go beyond reading are needed.

Revisiting Multifactor Models of Dyslexia: Do They Fit Empirical Data and What Are Their Implications for Intervention?

Developmental dyslexia can be viewed as the result of the effects of single deficits or multiple deficits. This study presents a test of the applicability of a multifactor-interactive model (MFi-M) with a preliminary set of five variables corresponding to different neuropsychological functions involved in the reading process. The model has been tested on a sample of 55 school-age children with developmental dyslexia. The results show that the data fit a model in which each variable contributes to the reading ability in a non-additive but rather interactive way. These findings constitute a preliminary validation of the plausibility of the MFi-M, and encourage further research to add relevant factors and specify their relative weights. It is further discussed how subtype-based intervention approaches can be a suitable and advantageous framework for clinical intervention in a MFi-M perspective.

Test Review of the Feifer Assessment of Reading (FAR)

The Feifer Assessment of Reading (FAR) is a comprehensive reading test for children ages 4 through 21 years. The FAR was designed to evaluate the underlying cognitive and linguistic processes of reading. It has 15 subtests to evaluate aspects of phonological development, orthographical processing, decoding, reading fluency, and comprehension skills. Academic achievement tests endeavor to evaluate core neuropsychological and theoretical perspectives that identify students at risk. However, reading tests have historically not focused on why a student may struggle with reading interventions. A neuropsychological approach to reading posits that multiple neural pathways assist the reading process. These processes include orthographic mapping, phonemic awareness, fluency, decoding, and comprehension. The aim of the test is to help the evaluator learn why a student is struggling with reading, as well as to inform intervention. This review explores the Feifer Assessment of Reading (FAR), and its contribution to the neuropsychological evaluation of reading.

Probabilistic Decision-Making in Children With Dyslexia

Background

Neurocognitive mechanisms underlying developmental dyslexia (dD) remain poorly characterized apart from phonological and/or visual processing deficits. Assuming such deficits, the process of learning complex tasks like reading requires the learner to make decisions (i.e., word pronunciation) based on uncertain information (e.g., aberrant phonological percepts)-a cognitive process known as probabilistic decision making, which has been linked to the striatum. We investigate (1) the relationship between dD and probabilistic decision-making and (2) the association between the volume of striatal structures and probabilistic decision-making in dD and typical readers.

Methods

Twenty four children diagnosed with dD underwent a comprehensive evaluation and MRI scanning (3T). Children with dD were compared to age-matched typical readers (n = 11) on a probabilistic, risk/reward fishing task that utilized a Bayesian cognitive model with game parameters of risk propensity (γ+) and behavioral consistency (β), as well as an overall adjusted score (average number of casts, excluding forced-fail trials). Volumes of striatal structures (caudate, putamen, and nucleus accumbens) were analyzed between groups and associated with game parameters.

Results

dD was associated with greater risk propensity and decreased behavioral consistency estimates compared to typical readers. Cognitive model parameters associated with timed pseudoword reading across groups. Risk propensity related to caudate volumes, particularly in the dD group.

Conclusion

Decision-making processes differentiate dD, associate with the caudate, and may impact learning mechanisms. This study suggests the need for further research into domain-general probabilistic decision-making in dD, neurocognitive mechanisms, and targeted interventions in dD.

The Percentages of Cognitive Skills Deficits among Chinese Children with Developmental Dyslexia: A Systematic Review and Meta-Analysis

The current study was conducted to examine the percentages of cognitive skills deficits among Chinese children with developmental dyslexia. Via a systematic review, we collated twenty-two available studies on the proportion of cognitive skills deficits, including phonological awareness, rapid automatized naming, morphological awareness, orthographic knowledge, short-term memory and working memory, and visual and motor skills deficits, among Chinese children with developmental dyslexia. The results of a meta-analysis showed that the rapid automatized naming deficits are the core deficit of developmental dyslexia among Chinese children, with a pooled percentage of 44%. This is followed by orthographic knowledge deficits (43%), phonological awareness deficits (41%), morphological awareness deficits (40%), visual and motor skills deficits (33%), and short-term memory and working memory deficits (25%). At the same time, we compared the proportions of different locations, ages, standards and control groups.

Remote Neuropsychological Intervention for Developmental Dyslexia with the Tachidino Platform: No Reduction in Effectiveness for Older Nor for More Severely Impaired Children

Tachidino is a web-platform for remote treatment of reading and writing disorders. A total of 91 children with developmental dyslexia and/or dysorthographia participated in the present study and received Tachidino treatment. The purpose of the study was to compare results obtained after four weeks treatment and a six-month follow-up in older versus younger children and in more versus less severely impaired children (separately subdividing them according to reading speed, reading accuracy, and writing accuracy). The results showed no difference in improvement for reading accuracy and speed in the three age groups, but children below 9 years improved more than older children in writing accuracy. Regarding severity groups, children with more severe initial impairments improved more than children with less severe impairments. Additionally, the results were confirmed after controlling for spurious effects due to use of Z-scores and regression to the mean. The findings are discussed in terms of their theoretical and practical implications.

Kindergarten screening tools filled out by parents and teachers targeting dyslexia. Predictions and developmental trajectories from age 5 to age 15 years

The concept of early 'efforts' has led to discussions for and against introducing language assessment for all kindergarten children. Evidence-based kindergarten screening tools completed by close caregivers could solve this controversy as the children themselves would only be indirectly involved. The aim of this study was to see whether the scores of such early screening tools aiming at developmental dyslexia could predict school marks of literacy competence 10 years later, and to see whether these screening tools would reveal different dyslexia trajectories. The study is part of the Bergen Longitudinal Dyslexia Study, and the results from individual testing are reported elsewhere. Here, the caregivers' views isolated from the rest of the study are focused. Three tools were used: the RI-5, a questionnaire assessing the risk of dyslexia; the TRAS, a non-standardized observation tool of children's communication skills; and the CCC-2, a questionnaire assessing Developmental Language Disorders. Screening was performed at age 5 (TP1), age 11, (TP2) and age 15 (TP3). At TP2, when dyslexia was identified, 13 children formed the dyslexia group, and the rest formed the control group. At TP3, the RI-5 and CCC-2 turned out to be predictive of literacy competence as measured by school marks. Developmental trajectories were seen through the regroupings and scorings into a persistent group, a late onset group and a resolving group. Evidence-based preschool screening tools filled out by close caregivers offer valid information on later literacy developmental trajectories.

Convergent and divergent brain structural and functional abnormalities associated with developmental dyslexia

Brain abnormalities in the reading network have been repeatedly reported in individuals with developmental dyslexia (DD); however, it is still not totally understood where the structural and functional abnormalities are consistent/inconsistent across languages. In the current multimodal meta-analysis, we found convergent structural and functional alterations in the left superior temporal gyrus across languages, suggesting a neural signature of DD. We found greater reduction in grey matter volume and brain activation in the left inferior frontal gyrus in morpho-syllabic languages (e.g. Chinese) than in alphabetic languages, and greater reduction in brain activation in the left middle temporal gyrus and fusiform gyrus in alphabetic languages than in morpho-syllabic languages. These language differences are explained as consequences of being DD while learning a specific language. In addition, we also found brain regions that showed increased grey matter volume and brain activation, presumably suggesting compensations and brain regions that showed inconsistent alterations in brain structure and function. Our study provides important insights about the etiology of DD from a cross-linguistic perspective with considerations of consistency/inconsistency between structural and functional alterations.

Overcoming theoretical stagnation through cultural–historical neuropsychology: The case of dyslexia

In this article we argue that cultural–historical neuropsychology manages to escape the theoretical stagnation that characterises the field of dyslexia. To support our argumentation, we first define cultural–historical psychology and neuropsychology and determine their subject matter. Afterwards, we provide an outline of how reading and reading difficulties are perceived through the prism of cultural–historical neuropsychology. We then discuss several mainstream conceptualisations of dyslexia that contribute to the theoretical stagnation in the field. Finally, we explain how cultural–historical neuropsychology avoids each theoretical barrier imposed by mainstream conceptualisations.

In Search of Cognitive Promotive and Protective Factors for Word Reading

This study examined whether strong cognitive skills (i.e. vocabulary, rapid naming, verbal working memory [VWM], and processing speed [PS]) contributed to resilience in single-word reading skills in children at risk for reading difficulties because of low phonological awareness scores (PA). Promotive factors were identified by main effects and protective factors through PA x cognition interactions. This study included 1,807 children ages 8-16. As predicted, all cognitive skills were significantly related to reading, consistent with promotive effects. A significant, but small effect PA x vocabulary interaction (R2 change=.002, p=.00038) was detected but its form was not consistent with a classic protective effect. Rather, the PA x vocabulary interaction was consistent with a "skill-enhancement" pattern, such that children with strong PA and vocabulary skills had better than expected reading. This study provides a framework for reading resilience research and directs attention to promotive mechanisms underlying reading success.

Investigating the double-deficit hypothesis of developmental dyslexia in an orthography of intermediate depth

The present study aimed to investigate the double-deficit hypothesis (DDH) in an orthography of intermediate depth. Eighty-five European Portuguese-speaking children with developmental dyslexia, aged 7 to 12, were tested on measures of phonological awareness (PA), naming speed (NS), reading, and spelling. The results indicated that PA and NS were not significantly correlated, and that NS predicts reading fluency (but not reading accuracy and spelling) beyond what is accounted for by PA. Although the majority of the children with developmental dyslexia have double deficit (62.4%), some children have a single phonological deficit (24.7%) or a single NS deficit (8.2%). Children with a double deficit were not more impaired in reading fluency, reading accuracy, and spelling than both single-deficit subtypes. In conclusion, the findings of the present study are partially consistent with the DDH and provide evidence for the multifactorial model of developmental dyslexia. Implications of the DDH for an orthography of intermediate depth are emphasized.

The Multiple Deficit Model: Progress, Problems, and Prospects

The multiple deficit model (MDM) was proposed because the prevailing single-deficit model provided an inadequate account of atypical neuropsychological development. Across methods and levels of analysis, there has been support for the two fundamental tenets of the MDM, that multiple predictors contribute probabilistically to neurodevelopmental disorders and shared risk factors contribute to comorbidity. Diagnostically, the multiplicity of factors means that no single cognitive deficit or combination of deficits can be used to rule in or out most neurodevelopmental disorders. Challenges for the MDM are that the theory is difficult to falsify and that current cross-sectional studies cannot establish causality. Prospects for further development of the MDM include incorporating an explicit focus on promotive and protective factors and pursuing mechanistic connections between multiple factors across levels of analysis.

Comorbidity of reading disabilities and ADHD: Structural and functional brain characteristics

Reading disabilities (RD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common developmental disorders. RD and ADHD frequently co-occur, which raises questions about how the disorders interact and to what extent they can be differentiated. To date, the underlying neural mechanisms leading to RD-ADHD comorbidity (COM) are not understood. In this study, structural and functional magnetic resonance imaging (fMRI) were combined with comprehensive behavioral testing in order to characterize the behavior, brain structure, and neural correlates of executive function, phonological processing and reading fluency in 60 children with clinical diagnoses of RD, ADHD, or COM, and controls. Whole-brain analyses of variance were performed on cortical thickness values and on the data of the three fMRI tasks to investigate overall group differences. To validate these findings, a region of interest analysis was performed in regions that have previously been shown to exhibit group differences in children with RD or ADHD using the same paradigms. The neuroimaging results demonstrated structural and functional atypicalities for COM in regions that are frequently associated with deficits in children with isolated ADHD or RD. A combination of shared and distinctive brain alterations between the clinical groups was identified, supporting the multiple deficit model for ADHD, RD, and its comorbidity.