An Epidemiological Study of Chinese Children with Developmental Dyslexia

White matter substrates underlying morphological awareness deficit in Chinese children with developmental dyslexia

BACKGROUND

Morphological awareness (MA) deficit is strongly associated with Chinese developmental dyslexia (DD). However, little is known about the white matter substrates underlying the MA deficit in Chinese children with DD.

METHODS

In the current study, 34 Chinese children with DD and 42 typical developmental (TD) children were recruited to complete a diffusion magnetic resonance imaging scan and cognitive tests for MA. We conducted linear regression to test the correlation between MA and DTI metrics, the structural abnormalities of the tracts related to MA, and the interaction effect of DTI metrics by group on MA.

RESULTS

First, MA was significant related to the right inferior occipito-frontal fascicle (IFO) and inferior longitudinal fsciculus (ILF), the bilateral thalamo-occipital (T_OCC) and the left arcuate fasciculus (AF); second, compared to TD children, Chinese children with DD had lower axial diffusivity (AD) in the right IFO and T_OCC; third, there were significant interactions between metrics (fractional anisotropy (FA) and radial diffusivity (RD)) of the right IFO and MA in groups. The FA and RD of the right IFO were significantly associated with MA in children with DD but not in TD children.

CONCLUSION

In conclusion, compared to TD children, Chinese children with DD had axonal degeneration not only in the ventral tract (the right IFO) but also the visuospatial tract (the right T_OCC) which were associated with their MA deficit. And Chinese MA involved not only the ventral tracts, but also the visuospatial pathway and dorsal tracts.

Altered effective connectivity on rapid automatized naming deficits in Chinese children with developmental dyslexia: An rs-fMRI study with Ganger causality analysis

Rapid Automatized Naming (RAN) is the core defect of developmental dyslexia (DD), requiring collaboration among brain areas to complete. However, it's still unclear which effective connectivity (EC) among brain areas are crucial for RAN deficits in Chinses children with DD. The current study aims to explore the EC among brain areas related to RAN deficits in Chinese children with DD. We recruited 36 Chinese children with DD and 64 typically developing (TD) children aged 8-12 to complete resting-state functional magnetic resonance imaging (rs-fMRI) scan. Granger causality analysis (GCA) was employed to analysis the EC among brain areas related to RAN, and to calculate the relationship between EC and RAN scores. Compared to TD group, the DD group exhibited significantly decreased EC from left precentral gyrus (PG) to right precuneus, left anterior cingulate and paracingulate gyrus (ACG), left calcarine and right angular, from left middle frontal gyrus (MFG) to left calcarine. Additionally, the DD group showed increased EC from right cuneus to left inferior frontal gyrus triangular part (IFGtri). The EC from left PG to left ACG was positively correlated with letters-RAN score. The results showed Chinese children with DD had both defect and compensatory mechanisms for their RAN deficits. The decreased EC output from left PG may be the core problem of the RAN deficits, which may influence the integration of visual-spatial information, attention, memory retrieval, and speech motor in speech production. The current study has important clinic implications for establishing intervention measures targeted brain.

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.

Exposure to organophosphate, pyrethroid, and neonicotinoid insecticides and dyslexia: Association with oxidative stress

Organophosphates (OPPs), pyrethroids (PYRs), and neonicotinoids (NNIs) are three major classes of insecticides used worldwide. They might compromise child neurodevelopment. However, few studies have explored the association between exposure to them and dyslexia. The present study aimed to investigate the association between dyslexia and exposure to the three classes of insecticides, as well as explore the potential role of oxidative stress in the association. A total of 355 dyslexic children and 390 controls were included in this study. The exposure biomarkers were determined by liquid chromatography-tandem mass spectrometry. Specifically, the exposure biomarkers included three typical metabolites of OPPs, three of PYRs, and nine of NNIs. Additionally, three typical oxidative stress biomarkers, namely, 8-hydroxy-2'-deoxyguanosine (8-OHdG) for DNA damage, 8-hydroxyguanosine (8-OHG) for RNA damage, and 4-hydroxy-2-nonenal-mercapturic acid (HNEMA) for lipid peroxidation were measured. The detection frequencies of the urinary biomarkers ranged from 83.9% to 100%. Among the target metabolites of the insecticides, a significant association was observed between urinary 3,5,6-trichloro-2-pyridinol (TCPy, the metabolite of chlorpyrifos, an OPP insecticide) and dyslexia. After adjusting for potential confounding variables, children in the highest quartile of TCPy levels had an increased odds of dyslexia (odds ratio [OR], 1.68; 95% confidence interval [CI]: 1.03, 2.75] in comparison to those in the lowest quartile. Among the three oxidative stress biomarkers, urinary HNEMA concentration showed a significant relationship with dyslexia. Children in the highest quartile of HNEMA levels demonstrated an increased dyslexic odds in comparison to those in the lowest quartile after multiple adjustments (OR, 1.64; 95% CI: 1.01, 2.65). Mediation analysis indicated a significant effect of HNEMA in the association between urinary TCPy and dyslexia, with an estimate of 17.2% (P < 0.01). In conclusion, this study suggested the association between urinary TCPy and dyslexia. The association could be attributed to lipid peroxidation partially.

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.

Prevalence of developmental dyslexia in primary school children: a protocol for systematic review and meta-analysis

BACKGROUND

Developmental dyslexia (DD) is a specific impairment during the acquisition of reading skills and may have a lifelong negative impact on individuals. Reliable estimates of the prevalence of DD serve as the basis for evidence-based health resource allocation and policy making. However, the prevalence of DD in primary school children varies largely across studies. Moreover, it is unclear whether there are differences in prevalence in different genders and writing systems. Hence, the present study aims to conduct a systematic review and meta-analysis to assess the global prevalence of DD and to explore related factors.

METHODS

We will undertake a comprehensive literature search in 14 databases, including EMBASE, PubMed, Web of Science, China National Knowledge Infrastructure and Cochrane, from their inception to June 2021. Cross-sectional and longitudinal studies that describe the prevalence of DD will be eligible. The quality of the included observational studies will be assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. The risk of bias will be determined by sensitivity analysis to identify publication bias.

RESULTS

One meta-analysis will be conducted to estimate the prevalence of DD in primary school children. Heterogeneity will be assessed in terms of the properties of subjects (e.g., gender, grade and writing system) and method of diagnosis in the included primary studies. Subgroup analyses will also be performed for population and secondary outcomes.

CONCLUSION

The results will synthesize the prevalence of DD and provide information for policy-makers and public health specialists.

Development and Evaluation of Orthographic Knowledge Awareness Scale for Children Aged 6–12 Years

Objective

This study primarily aimed to develop an orthographic knowledge awareness scale in Mandarin for children aged 6–12 years. Related factors affecting orthographic knowledge awareness in children were analyzed, and a basis for individualized intervention was provided to improve reading and writing.

Methods

A conceptual framework for orthographic knowledge awareness in children aged 6–12 years was determined through a detailed reading of the literature on Chinese character orthography, combined with qualitative interviews of the target population and consultation with experts. The orthographic knowledge awareness scale initially consisted of three versions: for grades 1–2 (210 items), grades 3–4 (207 items), and grades 5–6 (220 items), accumulating a total of 637 items. The initial scale was then used for the study involving children aged 6–12 years in Maanshan City, Jiangsu Province. Various approaches to screening items were comprehensively used to determine the formal version of the orthographic knowledge awareness scale. The official scale was ultimately used to conduct the third round of surveys among 1,354 children aged 6–12 years in ordinary primary schools located in 5 cities in Jiangsu Province, namely, Changzhou, Lianyungang, Nantong, Xuzhou, and Yangzhou. The reliability, validity, and discriminating power of the formal scale were evaluated.

Results

A total of 360 items were included in the formal version of the orthographic knowledge awareness scale. The formal scale was divided into three versions for grades 1–2, 3–4, and 5–6. Each grade version consisted of 120 items. The scale was composed of the stroke awareness test, radical awareness test, and left–right reversal test. The cumulative variance contribution rates of grades 1–2, 3–4, and 5–6 were 82.47, 61.71, and 64.19%, respectively. The Cronbach's α coefficients of the three-grade version of the scale were 0.989, 0.946, and 0.938; the split-half reliability coefficients were 0.925, 0.766, and 0.847; and the test–retest reliability coefficients were 0.847, 0.895, and 0.8928, respectively.

Conclusion

The proposed orthographic knowledge awareness scale for children aged 6–12 years exhibits good reliability and validity. The formal scale consisted of two dimensions: identification of left–right reversal at the stroke and radical levels and the left–right reversal at the whole character level. The two dimensions can more comprehensively reflect the ability of children to discriminate orthographic structures.

Influence of assistive technology applications on dyslexic students: The case of Saudi Arabia during the COVID-19 pandemic

In Saudi Arabia, the COVID-19 pandemic forced students with dyslexia to complete their learning through online applications, like their peers without dyslexia. This study explores the influence of assistive technology (AT) on improving the visual perception (VP) and phonological processing (PhP) abilities of students with dyslexia. Three learning applications were used (Google Classroom, Zoom, and Quizlet) as AT platforms. A quantitative approach was adopted based on a quasi-experimental design. Single-subject experimental methods were used to examine the influence of AT on improving students' VP, PhP, and frequency of access (FA). Fourteen students with dyslexia who were selected as participants through purposeful sampling were divided into two experimental groups based on gender. The results showed that AT influenced the VP, PhP, and FA in both experimental groups. Girls scored higher than boys in VP, PhP, and FA, and a positive correlation was found between VP and PhP with AT applications among girls and boys. A simple linear regression analysis showed that a significant and positive relationship exists between FA and the VP and PhP abilities of students with dyslexia through AT applications.

Is It Just Face Blindness? Exploring Developmental Comorbidity in Individuals with Self-Reported Developmental Prosopagnosia

Developmental prosopagnosia (DP)—or ‘face blindness’—refers to life-long problems with facial recognition in the absence of brain injury. We know that neurodevelopmental disorders tend to co-occur, and this study aims to explore if individuals with self-reported DP also report indications of other neurodevelopmental disorders, deficits, or conditions (developmental comorbidity). In total, 115 individuals with self-reported DP participated in this online cross-sectional survey. Face recognition impairment was measured with a validated self-report instrument. Indications of difficulties with navigation, math, reading, or spelling were measured with a tailored questionnaire using items from published sources. Additional diagnoses were measured with direct questions. We also included open-ended questions about cognitive strengths and difficulties. Results: Overall, 57% reported at minimum one developmental comorbidity of interest, with most reflecting specific cognitive impairment (e.g., in memory or object recognition) rather than diagnostic categories (e.g., ADHD, dyslexia). Interestingly, many participants reported cognitive skills or strengths within the same domains that others reported impairment, indicating a diverse pattern of cognitive strengths and difficulties in this sample. The frequency and diversity of self-reported developmental comorbidity suggests that face recognition could be important to consider in future investigations of neurodevelopmental comorbidity patterns.

Association between urinary propylene oxide metabolite and the risk of dyslexia

Although it is a probable human carcinogen, propylene oxide is widely applied in industry and daily life. However, data on neurodevelopmental effects of propylene oxide exposure among children are extremely limited. We aimed to determine the urinary concentrations of propylene oxide metabolite among school-aged children and evaluate the potential association of propylene oxide exposure with risk of dyslexia. A total of 355 dyslexic children and 390 controls were recruited from three cities (Jining, Wuhan, and Hangzhou) in China, between 2017 and 2020. Urinary N-acetyl-S-(2-hydroxypropyl)-L-cysteine (i.e., 2-hydroxypropyl mercapturic acid; 2-HPMA) was measured as the biomarker of propylene oxide exposure. The detection frequency of 2-HPMA was 100%. After adjusting for potential confounders, the odds ratio (OR) for dyslexia per 2-fold increase in urinary 2-HPMA was 1.19 [95% confidence interval (95% CI): 1.01, 1.40, P = 0.042]. Compared with the lowest quartile of urinary 2-HPMA concentrations, children with the highest quartile of 2-HPMA had a 1.63-fold (95% CI: 1.03, 2.56, P = 0.036) significantly increased risk of dyslexia, with a dose-response relationship (P-trend = 0.047). This study provides epidemiological data on the potential association between propylene oxide exposure and the risk of dyslexia in children. Further studies are warranted to confirm the findings and reveal the underlying biological mechanisms.

The Prevalence and Associated Risk Factors of Children With Reading Disabilities in a Multiethnic City: A Cross-Sectional Study

Numerous studies have been conducted to explore the risk factors for reading disabilities (RDs) among children. Based on these studies, factors such as gender, socioeconomic status, and the home literacy environment have been widely found to be associated with children who have RDs. However, children from a multiethnic city are seldom investigated. This study aimed to explore the prevalence of RDs and the potential environmental risk factors in Shihezi, Xinjiang, where people of multiple ethnicities, including Han and ethnic minority children, live and study together. A cross-sectional study was conducted in the city of Shihezi. A two-stage sampling strategy was applied to randomly select six primary schools in the city. In total, 6,539 students in grades two to six participated in this study. There were 6,065 valid questionnaires obtained for further analyses. We used the Dyslexia Checklist for Chinese Children and the Pupil Rating Scale to screen for the children with RDs. The χ² test and multivariate logistic regression were employed to reveal the potential risk factors of RDs. The prevalence of children with RDs was 3.38% in Shihezi City and was significantly different between Han (3.28%) and Uighur (7.42%) children (P < 0.05). There was no significant difference in the prevalence of RDs between Han and Hui children. Among these children with RDs, the gender ratio of boys to girls was nearly 2:1. Multiple logistic regression analysis showed that gender (P < 0.01), learning habits (P < 0.01), and the home literacy environment (P < 0.01) were associated with RD. The results may be useful in the early identification and intervention of children with RDs, especially among ethnic minorities.

Room to read: The effect of extra-large letter spacing and coloured overlays on reading speed and accuracy in adolescents with dyslexia

BACKGROUND

Coloured overlay and extra-large letter spacing may improve reading speed and accuracy in individuals with dyslexia; however, research has yet to identify which types of reading errors are diminished.

AIM

To determine the impact of extra-large letter spacing and colour overlay on reading and assess the impact of both interventions on reading errors.

SAMPLE

Thirty-two dyslexic children were matched on age, verbal and non-verbal IQ with 27 children with no diagnosis of dyslexia. The average age of each group was 13 years.

METHOD

Participants read four texts with either standard or extra-large letter spacing with or without a coloured overlay.

RESULTS

Extra-large letter spacing significantly improved reading speed more substantially for the dyslexia group. In addition, extra-large letters significantly reduced the number of missed word errors made by the dyslexia group. In contrast, coloured overlays did not significantly impact reading speed or the reduction of errors.

CONCLUSION

Increasing letter spacing is an effective way for teachers to improve reading skills in students with dyslexia.

The Influence of Articulatory Suppression on Reading Among Chinese Children With Developmental Dyslexia: An Eye-Movement Study

Objective: The study aimed to examine how the phonological loop influences reading ability and processing in Chinese children with developmental dyslexia (DD). Methods: This study included 30 children with DD and 37 children without DD. Two types of articles (i.e., scenery prose and narrative story) and two conditions (under the conditions of articulatory-suppression and silent reading) were applied. An eye-link II High-Speed Eye Tracker was used to track a series of eye-movement parameters. The data were analyzed by the linear Mixed-Effects model. Results: Compared with children without DD, Children with DD had lower reading achievement (RA), frequency of saccades (FS) and frequency of fixations (FF), longer reading time (RT) and average fixation duration (AFD), slower reading speed (RS), shorter average saccade amplitude (ASA) and fixation distance (FD), more number of fixations (NF), and number of saccades (NS). There were significant interactions between participant group and articulatory suppression on RT and FD. We also observed interaction effects between article types and articulatory suppression on RA, AFD, ASA, and FS. Conclusion: Children DD exhibit abnormal phonological loop and eye movements while reading. The role of articulatory suppression on reading varies with the presentation of DD and the article type.

Self-Concept in Primary School Student with Dyslexia: The Relationship to Parental Rearing Styles

Dyslexic children may be more likely to form a negative self-concept, especially with poor educational experiences and negative parenting. The purpose of the present study was to investigate the self-concept of Chinese dyslexic children in primary school, and explore the influence factors of self-concept as well as its relationship with parenting style. A total of 50 children with dyslexia and 50 non-dyslexics matched for age, grade and gender participated in the study. We used the Piers-Harris children's self-concept scale (PHCSS) and the Chinese version of Egna Minnen Beträffande Uppfostran for Children (EMBU-C) to evaluate the self-concept and parenting styles of the study population. Our results indicated that the academic competence, popularity and general self-concept in the dyslexic group were significantly lower than those in the control group (p < 0.05). Based on the multivariate linear regression, we also found that residence (β = -0.32, p < 0.05) and physical activity (β = 0.36, p < 0.01) may influence factors self-concept in dyslexic children. In addition, a moderate and positive correlation was found between the self-concept of physical appearance and maternal emotional warmth (r = 0.36, p < 0.05) by using the Spearman correlation analysis. Our outcomes suggested that children with dyslexia have a poorer self-concept than typical developing children. The self-concept of dyslexic children should be improved in order to achieve better physical and mental development.

The Prevalence of Dyslexia in Primary School Children and Their Chinese Literacy Assessment in Shantou, China

The epidemiological studies of Chinese developmental dyslexia (DD) in China are still limited. In addition, literacy assessment has seldom been performed for children with dyslexia, due to lack of uniform assessment tools. This study was aimed at investigating the prevalence rate of children with dyslexia, and to evaluate their Chinese reading ability. A total of 2955 students aged 7-12 years were enrolled by randomized cluster sampling. The study was divided into three stages. In stage I, all participating students were asked to finish the Combined Raven Test (CRT) and Chinese Vocabulary Test and Assessment Scale. In stage II, the Chinese teachers and parents of the children with suspected dyslexia were interviewed by psychiatrists, and finished the Dyslexia Checklist for Chinese Children (DCCC). In stage III, these children were evaluated by child psychiatrists for the diagnosis with or without dyslexia, according to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and their Chinese literacy was further evaluated by using the Chinese Reading Ability Test (CRAT). The prevalence rate of children with dyslexia was 5.4% in Shantou city, 8.4% in boys and 2.3% in girls, with a gender ratio of 3.7:1.0. Children with dyslexia scored lower in all the five subscales of the CRAT tests. including phonological awareness, morphological awareness, rapid automatized naming, orthographic awareness, and reading ability than the control group (all p < 0.001). This study suggested that the prevalence rate of Chinese dyslexia in Shantou city is roughly equivalent to that previously reported in China. Children with dyslexia have a relatively lower Chinese reading ability in all assessments.

Personality, Behavior Characteristics, and Life Quality Impact of Children with Dyslexia

Dyslexia is one of the most common neurobehavioral disorders. Children with dyslexia usually suffer from negative, behavior personality problems, and impacted life quality. We aimed to identify family environment factors for dyslexia, and to evaluate the personality, behavior characteristics and life quality of children with dyslexia. A total of 60 children diagnosed with dyslexia and 180 normal children that were aged 7-12 who speak Chinese were recruited from four primary schools in Shantou City, China. Self-designed questionnaire, children's edition of the Eysenck Personality Questionnaire (EPQ), Conners' Parent Rating Scale (CPRS), and Quality of Life scale for children and adolescents (QLSCA) were employed for investigation. Multiple logistic regressions show that antenatal training (OR = 0.36), higher household income, higher parents' educational levels, and parents engaging in white-collar jobs were negatively associated with dyslexia; while, family members also suffering from dyslexia (OR = 12.17), lower frequency of communication between parents and children, and worse parent-child relationship were positively associated with dyslexia. Children with dyslexia scored higher in psychoticism and neuroticism (p = 0.040, 0.008), but lower in extroversion and dissimulation than normal children (p = 0.025, 0.007) in the EPQ test. They tended to be more introversion (68.3% vs. 43.0%), psychoticism (25.0% vs. 13.3%), and neuroticism (46.7% vs. 18.8%) than the controls. In addition, children with dyslexia had higher scores in conduct problem, learning problem, hyperactivity, and Conners' index of hyperactivity (CIH) in CPRS test; and, lower scores of psychosocial function, physical and mental health, and satisfaction of living quality in QLSCA test (all p < 0.05). Several family environment and parenting factors were associated with children's dyslexia significantly. Children with dyslexia had the personality of psychoticism, neuroticism, introversion, and more behavioral problems. Dyslexia significantly impacted the children's quality of life. Our findings provide multiple perspectives for early intervention of dyslexia in children, particularly in family factors and the parenting environment.