Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations

Shared Reading of the Families With the Children With Chronic Disease

The aim of the study is to evaluate shared reading of families of children with chronic diseases. The mothers of children aged 2 to 6 years with chronic health problems who applied to the pediatric outpatient clinic between January and May 2022 were the study group, and the mothers of children with an acute health problem were the control group. The sociodemographic information form and "Child-Parent Shared Reading Activities Scale" were applied. At the end of the interview, 3 questions about shared reading were asked. A total of 187 children were enrolled in the study: 92 and 95 in the chronic disease group and control group, respectively. 57.6% of mothers of chronically ill children reported that the parents almost never did shared reading with their child. It was found that all mothers knew the importance of reading, but they could not support especially in the risky chronic disease group.

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report

Early literacy promotion in pediatric primary care supports parents and caregivers in reading with their children from birth, offering counseling in interactive, developmentally appropriate strategies and providing developmentally and culturally appropriate and appealing children's books. This technical report reviews the evidence that reading with young children supports language, cognitive, and social-emotional development. Promoting early literacy in pediatric primary care offers a strengths-based strategy to support families in creating positive childhood experiences, which strengthen early relational health. An increasing body of evidence, reviewed in this report, shows that clinic-based literacy promotion, provided with fidelity to an evidence-based model, has benefits for children, for parents and caregivers, and for pediatric physicians and advanced care providers as well. Reading with young children supports early brain development and the neural "reading network," and improves school readiness. High-quality literacy promotion is especially essential for children who face disparities and inequities because of social factors, systemic racism, and socioeconomic risk. All families benefit from high-quality and diverse books and from developmentally appropriate guidance supporting interactions around books and stories. Thus, literacy promotion can be a universal primary prevention strategy to strengthen families and support healthy development. Partnerships at community, local, and state levels offer opportunities for integration with other programs, services, and platforms. Literacy promotion in primary care pediatric practice, recognized by the American Academy of Pediatrics as an essential component since 2014, has become increasingly common. There are successful models for public funding at federal, state, county, and municipal levels, but sustainable funding, including payment to pediatric physicians and advanced care providers, remains a need so that the benefits of pediatric early literacy promotion and the joys of books and shared reading can truly be offered on a population level.

Association between urinary BTEX metabolites and dyslexic odds among school-aged children

Benzene, toluene, ethylbenzene, and xylene (BTEX) are ubiquitous in the environment, and all of them can cause neurotoxicity. However, the association between BTEX exposure and dyslexia, a disorder with language network-related regions in left hemisphere affected, remains unclear. We aimed to assess the relationship between BTEX exposure and dyslexic odds among school-aged children. A case-control study, including 355 dyslexics and 390 controls from three cities in China, was conducted. Six BTEX metabolites were measured in their urine samples. Logistic regression model was used to explore the association between the BTEX metabolites and the dyslexic odds. Urinary trans,trans-muconic acid (MU: a metabolite of benzene) was significantly associated with an increased dyslexic odds [odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.01, 1.50], and the adjusted OR of the dyslexic odds in the third tertile was 1.72 (95% CI: 1.06, 2.77) compared to that in the lowest tertile regarding urinary MU concentration. Furthermore, the association between urinary MU level and the dyslexic odds was more pronounced among children from low-income families based on stratified analyses. Urinary metabolite levels of toluene, ethylbenzene, and xylene were not found to be associated with the dyslexic odds. In summary, elevated MU concentrations may be associated with an increased dyslexic odds. We should take measures to reduce MU related exposure among children, particularly those with low family income.

Dyslexia is associated with urinary polycyclic aromatic hydrocarbon metabolite concentrations of children from China: Data from the READ program

It has been found that exposure to polycyclic aromatic hydrocarbons (PAHs) is associated with the risk of certain childhood neurodevelopmental disorders. However, no research has investigated the relationship between exposure to PAHs and children's dyslexia odds. The objective of this research was to investigate whether urinary mono-hydroxylated polycyclic aromatic hydrocarbons (OH-PAHs) are associated with increased dyslexia odds in Chinese children. We recruited 1,089 children (542 dyslexic children and 547 non-dyslexic children) for this case-control study. Ten OH-PAHs were measured in the participants' urine samples, which were collected between November 2017 and March 2023. Odds ratios (ORs) of the associations between the OH-PAHs and dyslexia were calculated using logistic regression models, after adjustment for the potential confounding factors. A significant association was found between urinary concentrations of 2-hydroxynaphthalene (2-OHNap) and the elevated odds of dyslexia. The children in the highest quartile of 2-OHNap had a higher OR of dyslexia (1.87, 95% CI: 1.07-3.27) than those in the lowest quartile (P-trend = 0.02) after adjustment for the covariates. After excluding children with maternal disorders during pregnancy, logistic regression analyses showed similar results. Our results suggested a possible association between PAH exposure and the elevated odds of dyslexia.

Association of exposure to phthalates and phthalate alternatives with dyslexia in Chinese primary school children

Previous studies have shown associations between children's exposure to phthalates and neurodevelopmental disorders. Whereas the impact of exposure to phthalate alternatives is understudied. This study aimed to evaluate the association of exposure to phthalates/their alternatives with the risk of dyslexia. We recruited 745 children (355 dyslexia and 390 non-dyslexia) via the Tongji Reading Environment and Dyslexia Research Project, and their urine samples were collected. A total of 26 metabolites of phthalates/their alternatives were measured. Multivariate logistic regression and quantile-based g-computation were used to estimate the associations of exposure to the phthalates/their alternatives with dyslexia. More than 80% of the children had 17 related metabolites detected in their urine samples. After adjustment, the association between mono-2-(propyl-6-hydroxy-heptyl) phthalate (OH-MPHP) with the risk of dyslexia was observed. Compared with the lowest quartile of OH-MPHP levels, the odds of dyslexia for the third quartile was 1.93 (95% CI 1.06, 3.57). Regarding mixture analyses, it was found that OH-MPHP contributed the most to the association. Further analyses stratified by sex revealed that this association was only observed in boys. Our results suggested a significantly adverse association of di-2-propylheptyl phthalate exposure with children's language abilities. It highlights the necessity to prioritize the protection of children's neurodevelopment by minimizing their exposure to endocrine-disrupting chemicals like di-2-propylheptyl phthalate.

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.

Rapid Online Assessment of Reading (ROAR): Evaluation of an Online Tool for Screening Reading Skills in a Developmental-Behavioral Pediatrics Clinic

OBJECTIVE

Reading difficulties are highly prevalent and frequently co-occur with other neurodevelopmental/behavioral conditions. It is difficult to assess reading routinely in pediatric clinical practice because of time and resource constraints. Rapid Online Assessment of Reading (ROAR) is an objective, gamified assessment that children take in a web browser without adult supervision. This study's purpose was to evaluate ROAR as a screening tool for reading difficulties in a clinical setting.

METHOD

A convenience sample of 6- to 14-year-old children, attending an in-person or telehealth visit in a developmental-behavioral pediatrics (DBP) clinic participated. Children took ROAR and completed the Woodcock-Johnson IV Letter-Word Identification (LWID) and Word Attack (WA). Basic Reading Skills (BRS), a standardized aggregate score of LWID and WA, was used as the gold-standard assessment. The strength of association between standard scores on ROAR and BRS was calculated. BRS scores < 90 (bottom quartile) were classified as poor readers. Receiver operating characteristic (ROC) curve analysis was used to assess the quality of ROAR as a screening test.

RESULTS

A sample of 41 children, 78% boys, mean age 9.5 years (SD 2.0 years), completed the study. The correlation of ROAR standard score with BRS was r = 0.66, p < 0.001. ROC curve analysis with ROAR scores accurately classified poor readers with an area under the curve (AUC) of 0.90.

CONCLUSION

ROAR is a useful objective screening tool to identify children at high risk for reading difficulties. Assessment of the tool during a busy clinic was challenging, and a larger replication is warranted.

Association of perchlorate, thiocyanate, and nitrate with dyslexic risk

Perchlorate, thiocyanate, and nitrate are sodium iodide symporter (NIS) inhibitors that disturb iodide uptake into the thyroid and have been implicated in child development. However, no data are available on the association between exposure to/related with them and dyslexia. Here, we examined the association of exposure to/related with the three NIS inhibitors with the risk of dyslexia in a case-control study. The three chemicals were detected in urine samples of 355 children with dyslexia and 390 children without dyslexia from three cities in China. The adjusted odds ratios for dyslexia were examined using logistic regression models. The detection frequencies of all the targeted compounds were 100%. After adjusting for multiple covariates, urinary thiocyanate was significantly associated with the risk of dyslexia (P-trend = 0.02). Compared with the lowest quartile, children within the highest quartile had a 2.66-fold risk of dyslexia (95% confidence interval: 1.32, 5.36]. Stratified analyses showed that the association between urinary thiocyanate level and the risk of dyslexia was more pronounced among boys, children with fixed reading time, and those without maternal depression or anxiety during pregnancy. Urinary perchlorate and nitrate levels were not associated with the risk of dyslexia. This study suggests the possible neurotoxicity of thiocyanate or its parent compounds in dyslexia. Further investigation is warranted to confirm our findings and clarify the potential mechanisms.