A Cumulative Risk and Resilience Model of Dyslexia

The critical role of instructional response in defining and identifying students with dyslexia: a case for updating existing definitions

We address defining and identifying students with dyslexia within the context of multi-tier systems of support (MTSS). We review proposed definitions of dyslexia, evidence for proposed definitional attributes, and emphasize the role of instructional response in identifying students with dyslexia. We identify dyslexia as individuals with specific deficits in reading and spelling single words combined with inadequate response to evidence-based instruction. We propose a hybrid identification process in which assessment is utilized within school-wide MTSS allowing for integration of routinely collected progress monitoring data as well integrating with more formal diagnostic measures. This proposed "hybrid" method demonstrates strong evidence for valid decision-making and directly informs instruction. We close proposing a revised definition of dyslexia that incorporates these elements.

Dyslexia in the 21st century: revisiting the consensus definition

Two decades after the International Dyslexia Association (IDA) adopted the 2002 consensus definition of dyslexia, this special issue of the Annals of Dyslexia revisits that definition in light of advances in scientific understanding and evolving needs. Through contributions from leading researchers and interdisciplinary teams, the issue examines the strengths and limitations of the definition as it has been applied in research, policy, and practice. Key themes emerged, which included reconsidering the need to include the neurobiological basis of dyslexia in the definition, the intersection of literacy challenges and mental health, and the role of context in shaping how dyslexia is defined. Contributors to this special issue also reflected on how the definition serves different audiences, including educators, policymakers, and families. As the IDA embarks on a thoughtful reassessment of the 2002 definition, this collection of articles offers insights to guide the path forward, ensuring the definition remains a robust tool for research, identification, intervention, and advocacy in the coming years.

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.

Do we really need a new definition of dyslexia? A commentary

We provide a commentary on current debates about the definition of dyslexia. We agree with others that dyslexia is best thought of as a dimensional disorder with the best established causal risk factor being a deficit in phonological processing. Dyslexia is particularly common in children from families with a history of dyslexia and in children with preschool language difficulties. We argue that definitions may differ depending upon their purpose. Traditional discrepancy definitions may be useful for research purposes, but when considering the provision of educational services discrepancy definitions are not useful since all children with reading difficulties require reading intervention regardless of their level of IQ.

Revisiting the definition of dyslexia

The International Dyslexia Association definition of dyslexia was updated 20 years ago and has been referenced frequently in research and practice. In this paper, researchers from the Florida Center for Reading Research consider the components of the definition and make recommendations for revisions. These include recognizing the persistence of word-reading, decoding, and spelling difficulties, acknowledging the multifactorial causal basis of dyslexia, clarifying exclusionary factors, and denoting comorbidity with other developmental disorders. It is also suggested that the academic and psychosocial consequences of dyslexia be highlighted to reinforce a preventive service delivery model. Lastly, the inclusion of dyslexia within a specific learning disability category is supported.

An interdisciplinary perspective on the strengths and weaknesses of the International Dyslexia Association definition of dyslexia

This commentary article describes the results of a Delphi Method discussion between an interdisciplinary team of state dyslexia policy implementers. The authors argue that the International Dyslexia Association (IDA) definition of dyslexia from 2001 skews toward the perspectives of the research community, inadvertently creating implementation challenges for school practice. The article describes how the authors reached this determination; why they believe Vaughn et al.'s (Annals of Dyslexia, 2024) proposed definition marks an improvement over the 2001 IDA definition; and the need for continued support in the dyslexia policy implementation process, including knowledge dissemination efforts and updates to other relevant policy documents. This collaboration between policymakers, educators, and researchers contributes to the special issue by considering how the definition of dyslexia is situated in policy and practice. In so doing, it addresses a longstanding gap in academic research on how policy implementers understand and use the IDA definition.

Stress, resilience, and emotional well-being in children and adolescents with specific learning disabilities

This article reviews the prevalence of stress and explores resilience factors in children and adolescents with specific learning disabilities (SLDs). We show that the increased stress and emotional challenges faced by this group are likely due to societal pressures and stigma. Recent findings on neuroendocrine changes in this population are discussed, suggesting a predisposition to psychiatric disorders. This review advocates for a societal shift towards the neurodiversity paradigm, which recognizes SLDs as natural variations in brain function, emphasizing individual strengths and promoting a more inclusive approach that values cognitive diversity. Such advocacy is likely important to combat stress and stigma in those with SLDs. This article also reviews recent work identifying resilience-promoting factors, such as perception of self and peer/teacher relationships, for enhancing emotional well-being and mental health for children and adolescents with SLD.

Assessing Beliefs About Intrinsic and Extrinsic Determinants of SLD: Evaluating the Factor Structure of a Novel Instrument

Schools conduct comprehensive psychoeducational evaluations to identify students with specific learning disabilities (SLDs) and determine whether they qualify for special education services. This decision-making process is complex and research has documented many factors influencing SLD identification decisions. One such factor may be decision-makers' beliefs about the underlying causes of SLD, including intrinsic and extrinsic factors. However, no studies to date have examined the underlying factor structure of the responses to prompts about the causes of SLD from intrinsic and extrinsic perspectives. This study was conducted with a sample of 521 school psychologists as part of a larger study examining decision-making during SLD identification. Using confirmatory factor analyses (CFA) to compare two theoretically plausible models, results suggested that a single latent factor best captured variability in responses to these prompts. Implications for assessing beliefs and how they impact the psychoeducational assessment process to identify SLDs are discussed, along with areas for future research.

The gift of dyslexia: what is the harm in it?

Dyslexia, characterized by word reading and spelling deficits, has historically been viewed through a medical model of disability. However, a countermovement has emerged, emphasizing the strengths and abilities of neurodiverse individuals, including those with dyslexia. The concept of neurodiversity, which was initially introduced to help inform understanding of a mild form of autism, has expanded to include dyslexia. The expansion has occurred alongside a similar portrayal of dyslexia as an advantage that comes with specific gifts, creating a positive stereotype. While intended to empower individuals with dyslexia, the translation of the concept of neurodiversity to dyslexia in this way can inadvertently stigmatize and isolate those who do not fit this positive stereotype of dyslexia. This review, following a perspective review article format, synthesizes existing literature on the purported gifts of dyslexia and the implications of both negative and positive stereotypes on the well-being of individuals with dyslexia. The findings of this review underscore the importance of dispelling myths about dyslexia and advocating against the use of stereotypes, both negative and positive, in portraying dyslexia. Doing so will help remove the harmful effects of stigmatization, stereotype threat, and the potential of a fixed mindset inherent to being stereotyped.

Rapid online assessment of reading and phonological awareness (ROAR-PA)

Phonological awareness (PA) is at the foundation of reading development: PA is introduced before formal reading instruction, predicts reading development, is a target for early intervention, and is a core mechanism in dyslexia. Conventional approaches to assessing PA are time-consuming and resource intensive: assessments are individually administered and scoring verbal responses is challenging and subjective. Therefore, we introduce a rapid, automated, online measure of PA-The Rapid Online Assessment of Reading-Phonological Awareness-that can be implemented at scale without a test administrator. We explored whether this gamified, online task is an accurate and reliable measure of PA and predicts reading development. We found high correlations with standardized measures of PA (CTOPP-2, r = .80) for children from Pre-K through fourth grade and exceptional reliability (α = .96). Validation in 50 first and second grade classrooms showed reliable implementation in a public school setting with predictive value of future reading development.

Reading problems and their connection with visual search and attention

Attention has been hypothesized to act as a sequential gating mechanism for the orderly processing of letters and words. These same visuoattentional processes are often assumed to partake in some but not all types of visual search. In the current study, 24 dyslexic and 36 typical readers completed an attentionally demanding visual conjunction search. Visual feature search served as an internal control. It has been suggested that reading problems should go hand in hand with specific problems in visual conjunction search-particularly elevated conjunction search slopes (time per search item)-often interpreted as a problem with visual attention. Results showed that reading problems were associated with slower visual search, especially conjunction search. However, reading deficits were not associated with increased conjunction search slopes but instead with increased search intercepts, traditionally not interpreted as reflecting attention. We discuss these results in the context of hypothesized visuoattentional problems in dyslexia. Remaining open to multiple interpretations of the data, the current study demonstrates that difficulties in visual search are associated with reading problems, in accordance with growing literature on visual cognition problems in developmental dyslexia.

Leveraging brain science for impactful advocacy and policymaking: The synergistic partnership between developmental cognitive neuroscientists and a parent-led grassroots movement to drive dyslexia prevention policy and legislation

Reading proficiency is crucial for academic, vocational, and economic success and has been closely linked to health outcomes. Unfortunately, in the United States, a concerning 63% of fourth-grade children are reading below grade level, with approximately 7%-10% exhibiting a disability in word reading, developmental dyslexia. Research in developmental cognitive neuroscience indicates that individuals with dyslexia show functional and structural brain alterations in regions processing reading and reading-related information, with some of these differences emerging as early as preschool and even infancy. This suggests that some children start schooling with less optimal brain architecture for learning to read, emphasizing the need for preventative education practices. This article reviews educational policies impacting children with dyslexia and highlights a decentralized parent-led grassroots movement, Decoding Dyslexia, which centers the voices of those directly impacted by dyslexia. It utilizes civic engagement practices, advocacy and lobbying on local, federal, and social media platforms, and strong partnerships with scientists to drive systems-level change in educational practices, leading to dyslexia prevention legislation across the U.S. The ongoing partnership continues to address the profound gaps between scientific findings and policymaking to drive systems-level change for contemporary challenges in educational practices within a learning disabilities framework.

Neurocognitive mechanisms of co-occurring math difficulties in dyslexia: Differences in executive function and visuospatial processing

Children with dyslexia frequently also struggle with math. However, studies of reading disability (RD) rarely assess math skill, and the neurocognitive mechanisms underlying co-occurring reading and math disability (RD+MD) are not clear. The current study aimed to identify behavioral and neurocognitive factors associated with co-occurring MD among 86 children with RD. Within this sample, 43% had co-occurring RD+MD and 22% demonstrated a possible vulnerability in math, while 35% had no math difficulties (RD-Only). We investigated whether RD-Only and RD+MD students differed behaviorally in their phonological awareness, reading skills, or executive functions, as well as in the brain mechanisms underlying word reading and visuospatial working memory using functional magnetic resonance imaging (fMRI). The RD+MD group did not differ from RD-Only on behavioral or brain measures of phonological awareness related to speech or print. However, the RD+MD group demonstrated significantly worse working memory and processing speed performance than the RD-Only group. The RD+MD group also exhibited reduced brain activations for visuospatial working memory relative to RD-Only. Exploratory brain-behavior correlations along a broad spectrum of math ability revealed that stronger math skills were associated with greater activation in bilateral visual cortex. These converging neuro-behavioral findings suggest that poor executive functions in general, including differences in visuospatial working memory, are specifically associated with co-occurring MD in the context of RD. RESEARCH HIGHLIGHTS: Children with reading disabilities (RD) frequently have a co-occurring math disability (MD), but the mechanisms behind this high comorbidity are not well understood. We examined differences in phonological awareness, reading skills, and executive function between children with RD only versus co-occurring RD+MD using behavioral and fMRI measures. Children with RD only versus RD+MD did not differ in their phonological processing, either behaviorally or in the brain. RD+MD was associated with additional behavioral difficulties in working memory, and reduced visual cortex activation during a visuospatial working memory task.

Twice-exceptionality unmasked: A systematic narrative review of the literature on identifying dyslexia in the gifted child

In this systematic narrative review, we synthesised the small existing body of research on children who are gifted and dyslexic (G-D) in order to investigate the claim that G-D students have a unique profile, characterised by well-masked word-level reading and spelling difficulties. Our focus was on both the cognitive and academic profiles of this subgroup of twice-exceptional (2e) children and the assessment protocols used to identify them. Findings suggest that despite having processing deficits associated with dyslexia, G-D students' gifted strengths, especially those relating to oral language, may enable them to compensate for their reading difficulties, at least to an extent that they fail to meet standard diagnostic criteria. However, G-D students also perform poorly on word-level reading, reading fluency and spelling tasks when compared with both control groups and their gifted, non-dyslexic peers, providing clear evidence of impaired achievement. Findings from this review highlight the need for (a) a more nuanced approach to the assessment of students presenting with highly discrepant profiles and (b) future research into both the cognitive and academic profiles and the instructional needs of this highly able yet poorly understood group of students, whose potential may be masked and thus underestimated in the school setting.

Assessment of Specific Learning Disabilities and Intellectual Disabilities

We review literature related to the assessment and identification of Specific Learning Disabilities (SLD) and Intellectual Disabilities (ID). SLD and ID are the only two disorders requiring psychometric test performance for identification within the group of neurodevelopmental disorders in Diagnostic and Statistical Manual - 5. SLD and ID are considered exclusionary of one another, but the processes for assessment and identification of each disorder vary. There is controversy about the identification and assessment methods for SLD, with little consensus. Unlike ID, SLD is weakly related to full-scale IQ, and there is insufficient evidence that the routine assessment of IQ or cognitive skills adds value to SLD identification and treatment. We have proposed a hybrid method based on the assessment of low achievement with norm-referenced tests, instructional response, and other disorders and contextual factors that may be comorbid or contraindicative of SLD. In contrast to SLD, there is strong consensus for a three-prong definition for the identification and assessment of ID: (a) significantly subaverage IQ, (b) adaptive behavior deficits that interfere with independent living in the community, and (c) age of onset in the developmental period. For both SLD and ID, we identify areas of controversy and best practices for identification and assessment.

Sequence Processing in Music Predicts Reading Skills in Young Readers: A Longitudinal Study

Musical abilities, both in the pitch and temporal dimension, have been shown to be positively associated with phonological awareness and reading abilities in both children and adults. There is increasing evidence that the relationship between music and language relies primarily on the temporal dimension, including both meter and rhythm. It remains unclear to what extent skill level in these temporal aspects of music may uniquely contribute to the prediction of reading outcomes. A longitudinal design was used to test a group-administered musical sequence transcription task (MSTT). This task was designed to preferentially engage sequence processing skills while controlling for fine-grained pitch discrimination and rhythm in terms of temporal grouping. Forty-five children, native speakers of Portuguese (Mage = 7.4 years), completed the MSTT and a cognitive-linguistic protocol that included visual and auditory working memory tasks, as well as phonological awareness and reading tasks in second grade. Participants then completed reading assessments in third and fifth grades. Longitudinal regression models showed that MSTT and phonological awareness had comparable power to predict reading. The MSTT showed an overall classification accuracy for identifying low-achievement readers in Grades 2, 3, and 5 that was analogous to a comprehensive model including core predictors of reading disability. In addition, MSTT was the variable with the highest loading and the most discriminatory indicator of a phonological factor. These findings carry implications for the role of temporal sequence processing in contributing to the relationship between music and language and the potential use of MSTT as a language-independent, time- and cost-effective tool for the early identification of children at risk of reading disability.

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.

Development and diagnostic accuracy of dyslexia early identification flowchart for pediatric practice

This study developed and evaluated the Rapid Automatized naming, Phonological Awareness, and Letter Identification (RAPALI) flowchart for early dyslexia identification in pediatric settings. Using early literacy skills at kindergarten level from the Thai emergent literacy for predicting dyslexia longitudinal study, the RAPALI flowchart effectively identified dyslexia risk at grade 3 level, boasting an AUC of 0.71, a sensitivity of 95.5%, and a negative predictive value of 99.1%. RAPALI demonstrated acceptable specificity and positive predictive value. The user-friendly flowchart aids early identification, interventions, and preventive measures for dyslexia, benefiting affected children and their families. However, further validation and adaptation are needed.

Understanding variation in prospective poor decoders: A person-centred approach from kindergarten to Grade 2

In the present study, we aimed to clarify variation in prospective poor decoders by studying the development of their word decoding skills during the first 1½ years of formal reading education and their unique pre-reading profiles before the onset of formal reading education. Using structural equation modelling and a factorial mixed model analysis of variance (ANOVA), we found autoregression and growth in the word decoding efficiency of prospective poor decoders (n = 90) and matched prospective adequate decoders (n = 90) in first and second grade. However, the gap between the two groups widened over time. Next, we zoomed in on the group of poor decoders by retrospectively studying their individual variation regarding cognitive and linguistic pre-reading skills. Using latent profile analysis, we found three distinct pre-reading profiles: (1) Poor PA, Letter Knowledge, RAN, and Verbal STM; (2) Poor PA and Letter Knowledge; and (3) Poor RAN. Together, these findings suggest that reading difficulties emerge at the intersection of multiple risk factors which can be detected in kindergarten, and that these reading problems persist throughout early reading education.

Longitudinal Predictors of Word Reading for Children with Williams Syndrome

We examined the cognitive, language, and instructional predictors of early word-reading ability in a sample of children with Williams syndrome longitudinally. At Time 1, sixty-nine 6-7-year-olds (mean age = 6.53 years) completed standardized measures of phonological awareness, visual-spatial perception, vocabulary, and overall intellectual ability. Word-reading instruction type was classified as (systematic) Phonics (n = 35) or Other (n = 34). At Time 2, approximately three years later (mean age = 9.47 years), children completed a standardized assessment of single-word reading ability. Reading ability at Time 2 varied considerably, from inability to read any words to word-reading ability slightly above the level expected for age. The results of a multiple regression indicated that Time 1 word-reading instruction type, phonological awareness, and visual-spatial perception (as assessed by a matching letter-like forms measure) each explained significant unique variance in word reading at Time 2. A systematic phonics approach was associated with significantly better performance than other reading-instruction approaches. Exploratory analyses suggested that the relations between these factors were complex. Considered together, these findings strongly suggest that, in line with the Cumulative Risk and Resilience Model of reading disability, word-reading (dis)ability in Williams syndrome is probabilistic in nature, resulting from the interaction of multiple individual and environmental risk and protective factors. The results also have educational implications: Early word-reading instruction for children with Williams syndrome should combine systematic phonics and phonological awareness training while also incorporating letter discrimination instruction highlighting the visual-spatial differences between similar-appearing letters.

A national test of dyslexia

Different definitions and tests of dyslexia can cause unfairness and make life difficult for people with dyslexia as well as for the professionals. In 2012, the Danish government decided to support the fight against dyslexia. The government issued a public tender for the development of "a standardized, electronically administered test of dyslexia for use […] from primary Grade 3 and up through all educational levels to 5-year university education." The present paper reports from the development of this National Dyslexia Test. The paper focuses on the definition of dyslexia and the composition, reliability, and validity of the test. Data from the development of the test demonstrate the psychometric properties of the test. Reliability was indicated by a high agreement between the two (computer-administered) measures that are part of the test. External convergent validity was indicated by a high agreement between test results and results from prior practice and by agreement between test results and reading comprehension of educational texts. The paper concludes with a discussion of the practical uses and potential issues with the test since its release in 2015.

Preliteracy Skills Mediate the Relation Between Early Speech Sound Production and Subsequent Reading Outcomes

PURPOSE

Learning to read is a complex, multifaceted process that relies on several speech and language-related subskills. Individual differences in word reading outcomes are indicated among children with inaccurate speech sound productions, with some of these children developing later reading difficulties. There are inconsistent reports as to whether phonological deficits and/or weaknesses in oral language explain these subsequent reading difficulties. Thus, it remains unclear how variability in speech production accuracy in early childhood may impact reading development. Therefore, the present longitudinal study seeks to clarify the relation between speech sound production accuracy in kindergarten and subsequent reading outcomes with a focus on additional potential mediating factors.

METHOD

Speech accuracy, core preliteracy skills (phonological awareness, rapid naming, and letter-name knowledge), and additional potential mediators (phonological memory and oral language abilities) were characterized at the start of formal reading instruction. Word reading, decoding, reading fluency, and comprehension were assessed at the end of second grade. Mediation analyses were conducted to examine factors that mediate the relation between speech accuracy in kindergarten and subsequent reading outcomes.

RESULTS

Initial associations between early speech sound production accuracy and subsequent reading outcomes were indicated; however, mediation effects of preliteracy skills (phonological awareness and letter-name knowledge) were identified for word reading, decoding, and reading fluency outcomes. For reading comprehension, mediation effects of preliteracy and vocabulary skills were observed.

CONCLUSIONS

The relation between speech sound production accuracy and subsequent word reading, decoding, reading fluency, and comprehension was observed to be mediated by preliteracy skills, specifically phonological awareness and letter-name knowledge. For reading comprehension only, vocabulary knowledge were of additional importance.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23671491.

Perceived negative consequences of dyslexia: the influence of person and environmental factors

Perceived negative consequences of dyslexia entail the degree to which an individual perceives negative outcomes, such as low academic achievement or feelings of anxiety and depression, and attributes these experiences to the disorder. In the current study, we examined how perceived consequences of dyslexia are influenced by person and environmental factors. Perceived consequences were evaluated for the academic domain and the domain of mental health (depression, anxiety). Participants were 123 Dutch students with dyslexia. Cognitive person factors (literacy skills and verbal IQ), socio-emotional person factors (self-perceived literacy skills and coping ability), and environmental factors (literacy demands, support from the institution, reactions of teachers and peers) were included as predictors. Results indicated that perceived negative consequences were not related to cognitive person factors. In contrast, better self-perceived literacy skills were associated with less perceived negative consequences in all domains (academic, depression, anxiety) and coping contributed to depression consequences. With respect to environmental factors, negative reactions in the academic environment contributed to perceived negative consequences of depression and anxiety. As such, findings indicate that individuals with dyslexia perceive negative consequences in the academic, anxiety, and depression domains which cannot be fully accounted for by their objective reading and writing problems. These factors should feature more prominently in future studies on dyslexia and should be addressed in treatment of dyslexia as well.

Analysis of Psychological and Social Functioning in Undergraduate Students with a Specific Learning Disorder (SLD)

It is considered to be particularly interesting to enrich the scientific overview investigating the comorbidities of specific learning disorders (SLDs) in young adults. Therefore, this study aims to investigate the psychosocial and relational profiles associated with the presence of learning difficulties in a population of university students. The hypothesis is that young adults with SLDs have lower psychological and socio-relational functioning than their typical-development peers. We further hypothesized that the socio-relational difficulties of students with SLDs could be explained not only by referring to the presence of a learning disorder, but also by considering some variables that may follow the experience of students with SLDs. The results highlighted that students with SLDs, compared to their typical-development peers, have low self-efficacy, high academic anxiety scores, emotional problems, and issues with peers. We finally suggest considering these aspects as early as the diagnostic process to facilitate an effective treatment plan for learning disorders to prevent, in terms of developmental trajectory, the manifestation of these aspects in adulthood.

The Role of Visual Factors in Dyslexia

What are the causes of dyslexia? Decades of research reflect a determined search for a single cause where a common assumption is that dyslexia is a consequence of problems with converting phonological information into lexical codes. But reading is a highly complex activity requiring many well-functioning mechanisms, and several different visual problems have been documented in dyslexic readers. We critically review evidence from various sources for the role of visual factors in dyslexia, from magnocellular dysfunction through accounts based on abnormal eye movements and attentional processing, to recent proposals that problems with high-level vision contribute to dyslexia. We believe that the role of visual problems in dyslexia has been underestimated in the literature, to the detriment of the understanding and treatment of the disorder. We propose that rather than focusing on a single core cause, the role of visual factors in dyslexia fits well with risk and resilience models that assume that several variables interact throughout prenatal and postnatal development to either promote or hinder efficient reading.

Rethinking Literacy Intervention: Addressing a Practice Gap With Best Practices From Multisensory Structured Language Approaches

PURPOSE

Dyslexia is increasingly being defined, assessed, diagnosed, and treated in the educational system. The purpose of this clinical focus article is to elucidate ways in which speech-language pathologists (SLPs) can rethink how to implement literacy interventions to incorporate best practices from multisensory structured language (MSL) approaches and how they can be influential participants in the conversations of how to define and implement services for students who have written language disorders, including dyslexia, in the school setting.

METHOD

This clinical focus article provides an operational definition of dyslexia, discusses the various roles and responsibilities of SLPs with respect to dyslexia, and describes the well-established evidence-based practices of MSL approaches as a means of rethinking literacy intervention.

RESULTS

Using a case study scenario based on an individual diagnosed with dyslexia, this clinical focus article presents similarities and differences between traditional speech-language pathology intervention approaches and MSL approaches to literacy intervention.

CONCLUSIONS

MSL strategies may be considered in literacy intervention as a means to optimize the academic gains of children with dyslexia in a school setting. Furthermore, SLPs should be considered integral participants in discussions of policies and practices related to the diagnosis and treatment of literacy disorders, including dyslexia.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23228483.

The Use of Cognitive Tests in the Assessment of Dyslexia

In this literature review, we address the use of cognitive tests, including intelligence tests, in the assessment and diagnosis of dyslexia, from both historic and present-day perspectives. We discuss the role of cognitive tests in the operationalization of the concepts of specificity and unexpectedness, two constructs considered essential to the characterization of dyslexia since the publication of early case reports in the late nineteenth century. We review the advantages and disadvantages of several approaches to specific learning disabilities' identification that are used in schools. We also discuss contemporary debates around the use of standardized cognitive testing in dyslexia evaluations, in particular, the arguments of those who favor an approach to diagnosis based on prior history and the results of a comprehensive evaluation and those who favor an approach based on an individual's response to intervention. We attempt to explain both perspectives by examining clinical observations and research findings. We then provide an argument for how cognitive tests can contribute to an accurate and informed diagnosis of dyslexia.

Executive Functions and Morphological Awareness Explain the Shared Variance Between Word Reading and Listening Comprehension

Purpose

A large body of literature showed that word reading and listening comprehension-two proximal predictors of reading comprehension according to the simple view of reading-are related. Grounded on the direct and indirect effects model of reading (Kim, 2020a, 2020b, 2023), we examined the extent to which the relation is explained by domain-general cognitions or executive functions (working memory and attentional control) and emergent literacy skills (language and code-related skills including morphological awareness, phonological awareness, orthographic pattern recognition, letter naming fluency, and rapid automatized naming).

Method

Data were from English-speaking children in Grade 1 (N = 372; 52% boys; 60% White children, 26% African American children, 6% multiracial children, 6% Hispanic children, and 2% Asian American children).

Results

Results from structural equation models showed that word reading and listening comprehension were moderately related (.54). When working memory and attentional control were included as predictors, the relation became weaker (.39). When morphological awareness was additionally included, they were no longer related (.05). The other emergent literacy skills did not add explanatory power beyond executive functions and morphological awareness.

Conclusion

These results indicate that executive functions and morphological awareness largely explain the shared variance between word reading and listening comprehension for English-speaking beginning readers.

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.

Heterogeneity in Reading Achievement and Mindset of Readers with Reading Difficulties

Recent research has focused on evaluating the relation between mindset and reading achievement. We used exploratory factor mixture models (E-FMMs) to examine the heterogeneity in reading achievement and mindset of 650 fourth graders with reading difficulties. To build E-FMMs, we conducted confirmatory factor analyses to examine the factor structure of scores of (a) mindset, (b) reading, and (c) mindset/reading combined. Our results indicated (a) a 2-factor model for mindset (General Mindset vs. Reading Mindset), (b) a 2-factor model for reading (Word Reading vs. Comprehension; four covariances), and (c) a combined model with significant correlations across mindset and reading factors. We ran E-FMMs on the combined model. Overall, we found three classes of students. We situate these results within the existing literature and discuss implications for practice and research.

A Real-World Data Study on the Impact of the ReadRx Cognitive Training and Reading Intervention on Cognition, Basic Reading Ability, and Psychosocial Skills for 3527 Children

Background

The state of reading proficiency among children in the United States continues to be a subject of concern among psychologists, teachers, parents, policy makers, and the education community at large. Despite the widespread use of curricular methods that teach basic reading skills, there remains a large percentage of children that struggle to read. Therefore, novel approaches to reading remediation should be explored.

Purpose

The aims of this study were to examine 1) the effect of a multicomponent cognitive and reading intervention on cognitive and reading skills; 2) the role of ADHD, age, sex, IQ score, and individual cognitive skills on the effectiveness of the ReadRx intervention; and 3) parent-reported behavioral outcomes following the ReadRx intervention.

Methods

The current study analyzed a large real-world dataset to examine cognitive, reading, and behavioral outcomes for struggling readers (n = 3527) who had completed 24 weeks (120 hours) of intense cognitive training integrated with a structured literacy intervention using ReadRx in a one-on-one clinic setting.

Results

Analyses of pretest and post-test scores showed statistically significant changes on all cognitive and reading measures including attention, visual processing, processing speed, long-term memory, working memory, reasoning, phonological awareness, Work Attack, phonetic coding, spelling, comprehension, and overall IQ score with medium to very large effect sizes. The results included an average 4.1-year gain in reading skills including a 6-year gain in phonological awareness. No differences were found based on age, sex, or ADHD status, and minimal differences were found based on pre-intervention IQ score and cognitive test scores. The study also included a qualitative thematic analysis of parent-reported behavioral outcomes revealing themes of improved cognition, academic performance, and psychosocial skills including confidence and perseverance.

Conclusion

Our findings were consistent with previous controlled studies on this intervention and offer an encouraging alternative instructional approach to reading remediation that aligns with the Science of Reading and includes intensive remediation of underlying cognitive skills.

Risk and resilience correlates of reading among adolescents with language-based learning disabilities during COVID-19

Students with language-based learning disabilities (LBLD) can face elevated socio-emotional well-being challenges in addition to literacy challenges. We examined the prevalence of risk and resilience factors among adolescents with LBLD (N = 93), ages 16-18, and the association with reading performance during the COVID-19 pandemic. Data were collected at the start and end of the first fully remote academic year of COVID-19 (2020-2021). Participants completed standardized word and text reading measures, as well as self-report surveys of executive functions (EF), and socio-emotional skills associated with resilience (grit, growth mindset, self-management, self-efficacy, and social awareness) or risk (anxiety, depression, COVID-19 related PTSD, and perceived COVID-19 impact). Survey data at the start of the school year (Time 1) captured three underlying factors associated with socioemotional risk, socioemotional resilience, and regulation (i.e., EF). Path analyses revealed that students' Time 2 oral reading scores were significantly and uniquely predicted by socioemotional resilience, even when controlling for word-level reading at Time 1. Socioemotional risk, EF, and perceived COVID-19 impact were not directly related to Time 2 oral reading scores; however, students' resilience mediated the associations between risk and reading outcomes. These results demonstrate that adolescents' mental health concerns, self-regulatory ability, and socioemotional resilience were all associated with their experiences of the COVID-19-related stress. However, despite the high-risk context of the pandemic, and socio-emotional challenges faced by students with LBLD, our findings indicate that resilience directly predicts end-of-year reading outcomes and mediates the impact of socioemotional risk on achievement.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11145-022-10361-8.

Multiple Case Studies in German Children with Dyslexia: Characterization of Phonological, Auditory, Visual, and Cerebellar Processing on the Group and Individual Levels

BACKGROUND

The underlying mechanisms of dyslexia are still debated. The question remains as to whether there is evidence of a predominant type of deficit or whether it is a multideficit disorder with individual profiles. The assumptions of which mechanism causes the disorder influences the selection of the training approach.

METHODS

A sample of German neurotypical reading children (NT) and children with dyslexia (DYSL) was investigated with a comprehensive behavioral test battery assessing phonological, auditory, visual, and cerebellar performance, thus addressing performance described in three major theories in dyslexia.

RESULTS

In the present sample using the test battery of the present study, DYSL had the strongest impairment in phonological and auditory processing, accompanied by individual processing deficits in cerebellar performance, but only a few in the investigated visual domains. Phonological awareness and auditory performance were the only significant predictors for reading ability.

CONCLUSION

These findings point out that those reading difficulties were associated with phonological as well as auditory processing deficits in the present sample. Future research should investigate individual deficit profiles longitudinally, with studies starting before literacy acquisition at as many processing domains as possible. These individual deficit profiles should then be used to select appropriate interventions to promote reading and spelling.

Exploring boundary conditions of the listening comprehension-reading comprehension discrepancy index

Conversations about the nature of dyslexia and how dyslexia impacts reading and listening comprehension get to the heart of classification and identification models of dyslexia. Recently, this conversation has been expanded to include efforts to estimate the prevalence of dyslexia in the population through the introduction of a discrepancy index of listening comprehension and reading comprehension. This discrepancy index was proposed to serve as a proxy for dyslexia when estimating its prevalence in the population. Individuals whose reading comprehension is considerably lower than their listening comprehension are thought to exhibit unexpected reading deficits. However, the index could underrepresent certain groups within the population. The current study explored this possibility using data from a sample of 4078 public-school students. We hypothesized that students from historically marginalized or otherwise disenfranchised groups (i.e., poor and minority groups) would be less likely to have a positive listening comprehension - reading comprehension (LC-RC) discrepancy index. Based on the results of multilevel linear mixed effect modeling, socioeconomic status (SES) contributed to differential performance on the discrepancy index when it was calculated using residual scores. Moreover, African American students were identified as having a reliably lower discrepancy index regardless of how it was calculated. It appears that this index, which only looks at the comprehension of language and not production, may, in fact, disadvantage students for whom oral language production differs from General American English (GAE). These outcomes suggest that this measure may lack the sensitivity to identify bidialectal students with dyslexia.

A better start literacy approach: effectiveness of Tier 1 and Tier 2 support within a response to teaching framework

The Better Start Literacy Approach (BSLA) is a strengths-based approach to supporting children's literacy learning in their first year of school. Previous research has shown the approach is effective at accelerating foundational literacy knowledge in children with lower levels of oral language. This study examined the impact of the BSLA for children with varied language profiles and across schools from diverse socioeconomic communities. Additionally, a controlled analysis of the impact of Tier 2 teaching within a response to teaching framework was undertaken. Participants included 402 five-year-old children from 14 schools in New Zealand. A randomised delayed treatment design was utilised to establish the effect of Tier 1 teaching. Analyses showed a significant Tier 1 intervention effect for phoneme awareness, letter-sound knowledge, non-word reading and non-word spelling. There was no difference in intervention effects across socioeconomic groupings. Children were identified for Tier 2 teaching after 10 weeks of Tier 1 implementation. The progress of 98 children in response to Tier 2 teaching was compared to 26 children who met Tier 2 criteria but received only Tier 1 teaching within this study. Children in the Tier 2 group scored significantly higher on phonological awareness, non-word reading, and spelling than the control group at the post-Tier 2 assessment point, after controlling for pre-Tier 2 scores. The results suggest that a proactive strengths-based approach to supporting foundational literacy learning in children's first year of school benefits all learners. The findings have important implications for early provision of literacy learning support in order to reduce current inequities in literacy outcomes.

Integration of visual motion and orientation signals in dyslexic children: an equivalent noise approach

Dyslexic individuals have been reported to have reduced global motion sensitivity, which could be attributed to various causes including atypical magnocellular or dorsal stream function, impaired spatial integration, increased internal noise and/or reduced external noise exclusion. Here, we applied an equivalent noise experimental paradigm alongside a traditional motion-coherence task to determine what limits global motion processing in dyslexia. We also presented static analogues of the motion tasks (orientation tasks) to investigate whether perceptual differences in dyslexia were restricted to motion processing. We compared the performance of 48 dyslexic and 48 typically developing children aged 8 to 14 years in these tasks and used equivalent noise modelling to estimate levels of internal noise (the precision associated with estimating each element's direction/orientation) and sampling (the effective number of samples integrated to judge the overall direction/orientation). While group differences were subtle, dyslexic children had significantly higher internal noise estimates for motion discrimination, and higher orientation-coherence thresholds, than typical children. Thus, while perceptual differences in dyslexia do not appear to be restricted to motion tasks, motion and orientation processing seem to be affected differently. The pattern of results also differs from that previously reported in autistic children, suggesting perceptual processing differences are condition-specific.