Assessment of Reading and Learning Disabilities A Research-Based Intervention-Oriented Approach

Responding to parental concern about children's reading

Objectives

This study explored if parents are accurate in their reading concerns, with implications for paediatric practice.

Methods

Parents of school-aged children in 34 schools in Ontario, Canada responded to a questionnaire about their children's academic development (27% response), and their children participated in standardized, norm-referenced tests of word reading and an oral sentence recall task. Parental concern status was retrospectively cross-referenced with reading difficulty status (<25th percentile on the word reading tests) for grade 2 children with complete data (n = 294); diagnostic accuracy was evaluated. Demographic and reading-related characteristics of children whose parents' concern did not match their reading difficulty status were explored.

Results

Approximately 22% of parents endorsed concern, while 18.5% of children had word reading difficulty. Parental concern status accurately corresponded with reading difficulty status in 81% of cases (95% CI: 76% to 85%). Specificity was 85% (95% CI: 80% to 90%), while sensitivity was 59% (95% CI: 44% to 73%). Children of unconcerned parents rarely had word reading problems (NPV 91%; 95% CI: 88% to 94%), while children with concerned parents had word reading difficulty in 45% of cases (PPV; 95% CI: 36% to 54%). Apparent inaccuracy (i.e., mismatch between parental concern and reading difficulty status) was related to children's word reading, oral sentence recall skills, and English language learner (ELL) status, but not child age, sex, or parent education.

Conclusions

Many parents of grade 2 children endorse reading concerns. Parental concern is an overall accurate screener for word reading difficulty, although some children will be missed. Evidence-informed recommendations for responding to parental concern are provided.

The Dimensionality of Oral Language Ability: Evidence From Young Greek Children

Purpose This study investigated component skills in oral language development utilizing and validating a new assessment battery in a large (N = 800) and representative sample of Greek students 4-7 years of age. Method All participants enrolled in public schools from four geographical regions (Attica, Thessaly, Macedonia, and Crete) that varied demographically (urban, semiurban, and rural). For the individualized language assessments, we utilized mobile devices (tablet PC) to ensure children's interest and joyful participation as well as reliable administration procedures across sites. Results by confirmatory factor analyses specified and validated five different models in each grade to identify the best conceptualization of language dimensionality in the respective age groups. Results Four-dimensional model provided a slightly better discriminant validity in language data of the preschool group. However, in kindergarten and first grades, the five-dimensional model had the best fit to the data to the four-dimensional. Conclusion These findings support the multidimensionality of oral language ability at this phase of development and increase of factor distinctiveness as children grow. Supplemental Material https://doi.org/10.23641/asha.12649214.

Considering the Role of Executive Function in Reading Comprehension: A Structural Equation Modeling Approach

In the present study, we used latent variable structural equation modeling to investigate relations between oral language, decoding, and two components of executive function (cognitive flexibility and working memory) and reading comprehension in a sample of 271 native English-speaking 9.00- to 14.83-year-olds. Results of the mediation analyses indicated that both oral language and decoding fully mediated the relations between working memory and cognitive flexibility and reading comprehension. These findings suggest that executive function is likely associated with reading comprehension through its relation with decoding and oral language and provide additional support for the role of executive function in reading comprehension as a potentially crucial precursor to skilled reading.

Novel reading index for identifying disordered reading skill development: A preliminary study

Children with ADHD are at high risk of developing a Reading Disability (RD), although the reasons remain unclear. ADHD-associated impairments, including processing speed, can complicate clinical evaluation for a co-occurring RD diagnosis. We propose a novel metric to (a) assess reading development and (b) provide an alternative method to classifying readers that may aid investigations for etiologies of RD in ADHD. Specifically, as both phonological decoding and word recognition skills are important precursors of reading fluency, we propose a new quantitative method comparing these skills after accounting for variations in perception, motor response, or processing speeds. Forty boys (14 control, 15 ADHD, 11 ADHD/ + RD) completed a lexical decision task testing decoding and another assessing word recognition. Response time data was modeled using a Drift Diffusion approach to estimate the underlying reading skills. Using these reading skill estimates, we calculated a novel Reading Tendency Index and classified participants into three reading groups (Decoders, Balanced Readers, and Sight Readers). The reading and cognitive performance of these groups were consistent with theoretical predictions and subsequently provided external validity for the novel Reading Tendency Index classification. Our findings demonstrate a potential classification tool for readers based on individual's developed, reading tendencies.

False memory for orthographically versus semantically similar words in adolescents with dyslexia: a fuzzy-trace theory perspective

The presented research was conducted in order to investigate the connections between developmental dyslexia and the functioning of verbatim and gist memory traces-assumed in the fuzzy-trace theory. The participants were 71 high school students (33 with dyslexia and 38 without learning difficulties). The modified procedure and multinomial model of Stahl and Klauer (simplified conjoint recognition model) was used to collect and analyze data. Results showed statistically significant differences in four of the model parameters: (a) the probability of verbatim trace recollection upon presentation of orthographically similar stimulus was higher in the control than dyslexia group, (b) the probability of verbatim trace recollection upon presentation of semantically similar stimulus was higher in the control than dyslexia group, (c) the probability of gist trace retrieval upon presentation of semantically similar stimulus was higher in the dyslexia than control group, and (d) the probability of gist trace retrieval upon target stimulus presentation (in the semantic condition) was higher in the control than dyslexia group. The obtained results suggest differences of memory functioning in terms of verbatim and gist trace retrieval between people with and without dyslexia on specific, elementary cognitive processes postulated by the fuzzy-trace theory. These can indicate new approaches in the education of persons with developmental dyslexia, focused on specific impairments and the strengths of their memory functioning.

Longitudinal stability of pre-reading skill profiles of kindergarten children: implications for early screening and theories of reading

Research suggests that early identification of developmental dyslexia is important for mitigating the negative effects of dyslexia, including reduced educational attainment and increased socioemotional difficulties. The strongest pre-literacy predictors of dyslexia are rapid automatized naming (RAN), phonological awareness (PA), letter knowledge, and verbal short-term memory. The relationship among these constructs has been debated, and several theories have emerged to explain the unique role of each in reading ability/disability. Furthermore, the stability of identification of risk based on these measures varies widely across studies, due in part to the different cut-offs employed to designate risk. We applied a latent profile analysis technique with a diverse sample of 1215 kindergarten and pre-kindergarten students from 20 schools, to investigate whether PA, RAN, letter knowledge, and verbal short-term memory measures differentiated between homogenous profiles of performance on these measures. Six profiles of performance emerged from the data: average performers, below average performers, high performers, PA risk, RAN risk, and double-deficit risk (both PA and RAN). A latent class regression model was employed to investigate the longitudinal stability of these groups in a representative subset of children (n = 95) nearly two years later, at the end of 1st grade. Profile membership in the spring semester of pre-kindergarten or fall semester of kindergarten was significantly predictive of later reading performance, with the specific patterns of performance on the different constructs remaining stable across the years. There was a higher frequency of PA and RAN deficits in children from lower socioeconomic status (SES) backgrounds. There was no evidence for the IQ-achievement discrepancy criterion traditionally used to diagnose dyslexia. Our results support the feasibility of early identification of dyslexia risk and point to the heterogeneity of risk profiles. These findings carry important implications for improving outcomes for children with dyslexia, based on more targeted interventions.

Academic Difficulties in Children with Prenatal Alcohol Exposure: Presence, Profile, and Neural Correlates

BACKGROUND

Academic achievement was evaluated in children with heavy prenatal alcohol exposure to determine potential strengths and weaknesses, evaluate the utility of different definitions for identifying low academic performance, and explore the neural correlates that may underlie academic performance.

METHODS

Children (8 to 16 years) were assessed using the WIAT-II. Patterns of performance were examined in 2 subject groups: children with heavy prenatal alcohol exposure (n = 67) and controls (n = 61). A repeated-measures MANCOVA examining group differences on academic domain (reading, spelling, math) scores was conducted. Post hoc comparisons examined within-group profiles. Numbers and percentage of children with low achievement were calculated using several criteria. In a subsample (n = 42), neural correlates were analyzed using FreeSurfer v5.3 to examine relations between cortical structure (thickness and surface area) and performance.

RESULTS

The alcohol-exposed group performed worse than controls on all domains and had a unique academic profile, supported by a significant group × academic domain interaction (p < 0.001). For the alcohol-exposed group, math reasoning was significantly lower than numerical operations, which was significantly lower than spelling and word reading. Over half of the alcohol-exposed group (58.2%) demonstrated low achievement on 1 or more academic domains. The number and percentage of children meeting criteria for low achievement varied based on the domain and definition used. The imaging analysis identified several surface area clusters that were differentially related to math (L superior parietal and R lateral/middle occipital) and spelling (bilateral inferior and medial temporal) performance by group, with no relations for the other academic domains. Generally, scores improved as surface area decreased in controls, whereas no relation or a positive relation was observed in the alcohol-exposed group.

CONCLUSIONS

Alcohol-exposed children demonstrated deficits in academic performance across domains and definitions, with a relative weakness in math functioning. Atypical brain development may contribute to these impairments in academic achievement. Understanding academic difficulties can assist in advocating effectively for alcohol-exposed children.

Cross-Study Differences in the Etiology of Reading Comprehension: a Meta-Analytical Review of Twin Studies

Numerous twin studies have examined the genetic and environmental etiology of reading comprehension, though it is likely that etiological estimates are influenced by unidentified sample conditions (e.g. Tucker-Drob and Bates, Psychol Sci:0956797615612727, 2015). The purpose of this meta-analysis was to average the etiological influences of reading comprehension and to explore the potential moderators influencing these estimates. Results revealed an average heritability estimate of h² = 0.59, with significant variation in estimates across studies, suggesting potential moderation. Moderation results indicated publication year, grade level, project, zygosity methods, and response type moderated heritability estimates. The average shared environmental estimate was c² = 0.16, with publication year, grade and zygosity methods acting as significant moderators. These findings support the role of genetics on reading comprehension, and a small significant role of shared environmental influences. The results suggest that our interpretation of how genes and environments influence reading comprehension should reflect aspects of study and sample.

The written expression abilities of adolescents with Attention-Deficit/Hyperactivity Disorder

Students with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience deficits in academic achievement. Written expression abilities in this population have not been extensively studied but existing prevalence estimates suggest that rates of comorbid writing underachievement may be substantially higher than rates of comorbid reading and mathematics underachievement. The current study examined written expression abilities in a school-based sample of 326 middle school age students with ADHD. The prevalence of written expression impairment, the associations between written expression and academic outcomes, and specific patterns of written expression were investigated. Students with ADHD in this sample experienced written expression impairment (17.2-22.4%) at a similar rate to reading impairment (17.0-24.3%) and at a slightly lower rate than mathematics impairment (24.7-36.3%). Students' written expression abilities were significantly associated with school grades and parent ratings of academic functioning, above and beyond the influence of intelligence. Analyses of patterns suggest that students with ADHD exhibit greater deficits in written expression tasks requiring organization and attention to detail, especially in the context of a complex task.

Putative risk factors in developmental dyslexia: a case-control study of Italian children

Although dyslexia runs in families, several putative risk factors that cannot be immediately identified as genetic predict reading disability. Published studies analyzed one or a few risk factors at a time, with relatively inconsistent results. To assess the contribution of several putative risk factors to the development of dyslexia, we conducted a case-control study of 403 Italian children, 155 with dyslexia, by implementing a stepwise logistic regression applied to the entire sample, and then to boys and girls separately. Younger parental age at child's birth, lower parental education, and risk of miscarriage significantly increased the odds of belonging to the dyslexia group (19.5% of the variation). These associations were confirmed in the analyses conducted separately by sex, except for parental education, which significantly affected only males. These findings support reading disabilities as a multifactorial disorder and may bear some importance for the prevention and/or early detection of children at heightened risk for dyslexia.

Collective screening tools for early identification of dyslexia

Current response to intervention models (RTIs) favor a three-tier system. In general, Tier 1 consists of evidence-based, effective reading instruction in the classroom and universal screening of all students at the beginning of the grade level to identify children for early intervention. Non-responders to Tier 1 receive small-group tutoring in Tier 2. Non-responders to Tier 2 are given still more intensive, individual intervention in Tier 3. Limited time, personnel and financial resources derail RTI’s implementation in Brazilian schools because this approach involves procedures that require extra time and extra personnel in all three tiers, including screening tools which normally consist of tasks administered individually. We explored the accuracy of collectively and easily administered screening tools for the early identification of second graders at risk for dyslexia in a two-stage screening model. A first-stage universal screening based on collectively administered curriculum-based measurements was used in 45 7 years old early Portuguese readers from 4 second-grade classrooms at the beginning of the school year and identified an at-risk group of 13 academic low-achievers. Collectively administered tasks based on phonological judgments by matching figures and figures to spoken words [alternative tools for educators (ATE)] and a comprehensive cognitive-linguistic battery of collective and individual assessments were both administered to all children and constituted the second-stage screening. Low-achievement on ATE tasks and on collectively administered writing tasks (scores at the 25th percentile) showed good sensitivity (true positives) and specificity (true negatives) to poor literacy status defined as scores ≤1 SD below the mean on literacy abilities at the end of fifth grade. These results provide implications for the use of a collectively administered screening tool for the early identification of children at risk for dyslexia in a classroom setting.

Reading skills of students with speech sound disorders at three stages of literacy development

PURPOSE

The relationship between phonological awareness, overall language, vocabulary, and nonlinguistic cognitive skills to decoding and reading comprehension was examined for students at 3 stages of literacy development (i.e., early elementary school, middle school, and high school). Students with histories of speech sound disorders (SSD) with and without language impairment (LI) were compared to students without histories of SSD or LI (typical language; TL).

METHOD

In a cross-sectional design, students ages 7;0 (years;months) to 17;9 completed tests that measured reading, language, and nonlinguistic cognitive skills.

RESULTS

For the TL group, phonological awareness predicted decoding at early elementary school, and overall language predicted reading comprehension at early elementary school and both decoding and reading comprehension at middle school and high school. For the SSD-only group, vocabulary predicted both decoding and reading comprehension at early elementary school, and overall language predicted both decoding and reading comprehension at middle school and decoding at high school. For the SSD and LI group, overall language predicted decoding at all 3 literacy stages and reading comprehension at early elementary school and middle school, and vocabulary predicted reading comprehension at high school.

CONCLUSION

Although similar skills contribute to reading across the age span, the relative importance of these skills changes with children's literacy stages.

Specific learning disability and its newest definition: which is comprehensive? And which is insufficient?

The American Psychiatric Association's proposed definition of specific learning disability ("specific learning disorder") for the DSM-5 reflects current thinking and best practice in learning disabilities. It continues the core conceptualization of learning disability (LD) as well as proposes identification criteria to supplant the discredited aptitude-achievement discrepancy formula. Improvements can be found along with long-standing and new controversies about the nature of LD. The proposed definition both provides a model of a currently acceptable definition and reflects critical issues in the operationalization of LD that the field continues to neglect.

Accelerating chronically unresponsive children to tier 3 instruction: what level of data is necessary to ensure selection accuracy?

Response-to-intervention (RTI) approaches to disability identification are meant to put an end to the so-called wait-to-fail requirement associated with IQ discrepancy. However, in an unfortunate irony, there is a group of children who wait to fail in RTI frameworks. That is, they must fail both general classroom instruction (Tier 1) and small-group intervention (Tier 2) before becoming eligible for the most intensive intervention (Tier 3). The purpose of this article was to determine how to predict accurately which at-risk children will be unresponsive to Tiers 1 and 2, thereby allowing unresponsive children to move directly from Tier 1 to Tier 3. As part of an efficacy study of a multitier RTI approach to prevention and identification of reading disabilities (RD), 129 first-grade children who were unresponsive to classroom reading instruction were randomly assigned to 14 weeks of small-group, Tier 2 intervention. Nonresponders to this instruction (n = 33) were identified using local norms on first-grade word identification fluency growth linked to a distal outcome of RD at the end of second grade. Logistic regression models were used to predict membership in responder and nonresponder groups. Predictors were entered as blocks of data from least to most difficult to obtain: universal screening data, Tier 1 response data, norm referenced tests, and Tier 2 response data. Tier 2 response data were not necessary to classify students as responders and nonresponders to Tier 2 instruction, suggesting that some children can be accurately identified as eligible for Tier 3 intervention using only Tier 1 data, thereby avoiding prolonged periods of failure to instruction.

Knowledge about and preoccupation with reading disabilities: a delicate balance

This study investigated the extent to which children's knowledge about reading disabilities, preoccupation with their own reading disability, and anxiety predicted reading comprehension in fifth and sixth grade children with reading disabilities (N=85). Participants provided rich and accurate information about reading disabilities and the academic and emotional implications of having a reading disability. Children's knowledge about the characteristics of reading disabilities was positively associated with reading comprehension, and preoccupation with their own disability was negatively associated with reading comprehension. Girls reported higher levels of preoccupation and anxiety than boys did. In addition to gender, children's reading comprehension, trait anxiety, and perceptions of their mothers' worry about their reading disabilities predicted their preoccupation with their own disability. Children with the most adaptive profile in terms of reading comprehension and anxiety were those who had high levels of knowledge and low levels of preoccupation with their disability.

Systematic Screenings to Prevent the Development of Learning and Behavior Problems: Considerations for Practitioners, Researchers, and Policy Makers

In this article, we discuss the importance of systematic screenings to monitor K—12 students’ behavioral and academic performance, with an emphasis on the need to identify and support students with emotional and behavioral disorders before they develop significant learning and behavior problems requiring special education services under the category of emotional disturbances. We emphasize the importance of conducting systematic screenings across the K—12 grade span within the context of comprehensive, integrated, three-tiered models of prevention. We provide brief descriptions of some of the current tools available to assess academic and behavioral performance patterns over time and present a balanced discussion of the benefits and challenges associated with the screening. Specifically, we describe how these measures can be used to (a) assess overall levels of performance within and across the school years and (b) identify students who may require secondary and tertiary levels of prevention beyond primary prevention efforts. We conclude with responsibilities that come with conducting screenings, with specific considerations for practitioners, researchers, and policy makers.

Modeling the Relationships Between Cognitive and Reading Measures in Third and Fourth Grade Children

The relationships between cognitive and reading measures in third and fourth grade children were analyzed using path modeling. Third graders were tested in word identification, pseudo word reading, orthographic speed, rapid naming, and oral vocabulary knowledge. In third and fourth grades, the students were tested in oral reading fluency and in reading comprehension with a statewide reading test. Path modeling using word identification, oral reading fluency, and reading comprehension as dependent variables indicated a very good fit (normed fit index of .99 for both third and fourth grades). The pattern of predictors differed depending on the reading outcome variable. The independent predictors of oral reading fluency were oral vocabulary knowledge, pseudo word reading, rapid naming, and a novel test of orthographic speed. The test of orthographic speed also made a unique contribution to word identification. Oral vocabulary knowledge was a unique predictor of reading comprehension for both models.

Traditional and computer-based screening and diagnosis of reading disabilities in Greek

In this study, we examined the characteristics of reading disability (RD) in the seventh grade of the Greek educational system and the corresponding diagnostic practice. We presented a clinically administered assessment battery, composed of typically employed tasks, and a fully automated, computer-based assessment battery that evaluates some of the same constructs. In all, 261 children ages 12 to 14 were tested. The results of the traditional assessment indicated that RD concerns primarily slow reading and secondarily poor reading and spelling accuracy. This pattern was matched in the domains most attended to in expert student evaluation. Automatic (computer-based) screening for RD in the target age range matched expert judgment in validity and reliability in the absence of a full clinical evaluation. It is proposed that the educational needs of the middle and high school population in Greece will be best served by concentrating on reading and spelling performance--particularly fluency--employing widespread computer-based screening to partially make up for expert-personnel shortage.

Intensive instruction affects brain magnetic activity associated with oral word reading in children with persistent reading disabilities

Fifteen children ages 7 to 9 years who had persistent reading difficulties despite adequate instruction were provided with intensive tutorial interventions. The interventions targeted deficient phonological processing and decoding skills for 8 weeks (2 hours per day) followed by an 8-week, 1-hour-per-day intervention that focused on the development of reading fluency skills. Spatiotemporal brain activation profiles were obtained at baseline and after each 8-week intervention program using magnetoencephalography during the performance of an oral sight-word reading task. Changes in brain activity were found in the posterior part of the middle temporal gyrus (Brodmann's Area [BA] 21: increased degree of activity and reduced onset latency), the lateral occipitotemporal region (BA 19/37: decreased onset latency of activation), and the premotor cortex (increased onset latency). Overall changes associated with the intervention were primarily normalizing, as indicated by (a) increased activity in a region that is typically involved in lexical--semantic processing (BA 21) and (b) a shift in the relative timing of regional activity in temporal and frontal cortices to a pattern typically seen in unimpaired readers. These findings extend previous results in demonstrating significant changes in the spatiotemporal profile of activation associated with word reading in response to reading remediation.

Magnetic source imaging studies of dyslexia interventions

Rapidly accumulating evidence from functional brain imaging studies indicates that developmental reading disability is associated with a functional disruption of the brain circuits that normally develop to support reading-related processes. This article briefly overviews recent advances in methods that capture the anatomical outline and temporal (dynamic) features of regional brain activation during performance of reading tasks. One of these methods, magnetoencephalography (MEG) or magnetic sources imaging (MSI) is described in more detail in the context of investigations of changes in spatiotemporal patterns of brain activity associated with improvement in reading skills in response to various types of educational interventions.

Evidence-based assessment of learning disabilities in children and adolescents

The reliability and validity of 4 approaches to the assessment of children and adolescents with learning disabilities (LD) are reviewed, including models based on (a) aptitude-achievement discrepancies, (b) low achievement, (c) intra-individual differences, and (d) response to intervention (RTI). We identify serious psychometric problems that affect the reliability of models based on aptitude-achievement discrepancies and low achievement. There are also significant validity problems for models based on aptitude-achievement discrepancies and intra-individual differences. Models that incorporate RTI have considerable potential for addressing both the reliability and validity issues but cannot represent the sole criterion for LD identification. We suggest that models incorporating both low achievement and RTI concepts have the strongest evidence base and the most direct relation to treatment. The assessment of children for LD must reflect a stronger underlying classification that takes into account relations with other childhood disorders as well as the reliability and validity of the underlying classification and resultant assessment and identification system. The implications of this type of model for clinical assessments of children for whom LD is a concern are discussed.

Agreement among four models used for diagnosing learning disabilities

We compared the level of agreement among four models used to diagnose learning disabilities (LD), including the simple discrepancy, intraindividual, intellectual ability-achievement, and underachievement models. The sample included 170 clinic-referred university students. The simple discrepancy model diagnosed significantly more students with LD than the other three models. The highest degree of agreement occurred between the intraindividual and intellectual ability-achievement models (70%); the lowest level of agreement occurred between the simple discrepancy and underachievement models (48%). Finally, only two of the six comparisons among the four models demonstrated significant correlations. We conclude that even when discrepancy models diagnose similar numbers of students with LD, the same students are not diagnosed across different models.