The lost children: The underdiagnosis of dyslexia in Italy. A cross-sectional national study

Cognitive, Social, and Emotional-Behavioral Outcomes in Children and Adolescents With Beckwith-Wiedemann Syndrome

Although Beckwith-Wiedemann syndrome spectrum (BWSp) is not usually associated with intellectual disability, recent evidences calls for further investigation of cognitive development and academic skills in children with BWSp. Moreover, research has documented social difficulties and emotional-behavioral problems associated with BWSp. Nevertheless, a full characterization of socio-emotional development in BWSp is still lacking. In the current study, cognitive and socio-emotional development was assessed in 29 children with BWSp aged 5-18 years, using a test of nonverbal intelligence, a neuropsychological battery covering multiple domains, academic skills tests, and questionnaires evaluating autistic traits and emotional-behavioral problems. As expected, most participants showed adequate performance in cognitive tests. However, the findings also highlighted greater difficulties in language than visuospatial processing, strengths in social perception, as well as slowness in reading and mental calculation. The assessment of emotional-behavioral difficulties indicated a prevalent phenotype characterized by increased anxiety, low self-esteem, social withdrawal and a tendency to control externalizing reactions, but no associations with autistic traits, cognitive outcomes, and the clinical score proposed by the recent Consensus statement. Increased social perception and internalization problems likely result from coping strategies with social and care-related stress. Overall, the findings of this study inform clinical management and genetic counseling for children and adolescents with BWSp.

Neuropsychology and Electroencephalography in Rural Children at Neurodevelopmental Risk: A Scoping Review

Children from rural areas face numerous possibilities of neurodevelopmental conditions that may compromise their well-being and optimal development. Neuropsychology and electroencephalography (EEG) have shown strong agreement in detecting correlations between these two variables and suggest an association with specific environmental and social risk factors. The present scoping review aims to describe studies reporting associations between EEG features and cognitive impairment in children from rural or vulnerable environments and describe the main risk factors influencing EEG abnormalities in these children. The method for this purpose was based on a string-based review from PubMed, EBSCOhost, and Web of Science, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Qualitative and quantitative analyses were conducted from the outcomes that complied with the selected criteria. In total, 2280 records were identified; however, only 26 were eligible: 15 for qualitative and 11 for quantitative analysis. The findings highlight the significant literature on EEG and its relationship with cognitive impairment from studies in children with epilepsy and malnutrition. In general, there is evidence for the advantages of implementing EEG diagnosis and research techniques in children living under risk conditions. Specific associations between particular EEG features and cognitive impairment are described in the reviewed literature in children. Further research is needed to better describe and integrate the state of the art regarding EEG feature extraction.

Is Specific Learning Disorder Predicted by Developmental Language Disorder? Evidence from a Follow-Up Study on Italian Children

Specific Learning Disorder (SLD) is a complex disorder with a strong genetic component, characterized by varying manifestations and considerable differences among children. Several studies have highlighted that difficulties in language acquisition and the presence of Developmental Language Disorders (DLDs) are frequently associated with SLD, suggesting a continuity between the two disorders. This study aimed to add evidence on the proximal and distal predictors of SLD, focusing on the eventual continuity for the presence of DLD at 4-5 years, on some linguistic and communicative abilities at 27-30 months, and on biological and environmental factors. Our sample consisted of 528 families, whose children (Italian monolingual) participated in a screening program at the age of 27-30 months. When children were on average 8.05 years old, parents were asked to answer an interview aimed at collecting information about the children's language and learning development. Results showed that the prevalence of children with an SLD (7.01%) was in line with those reported in other similar studies. The diagnosis of SLD was significantly predicted by the previous diagnosis of DLD, by male sex/gender, and by the familial risk of SLD. Children with these characteristics had a 54% probability of presenting an SLD.

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.

Prevalence of Developmental Dyslexia in Primary School Children: A Systematic Review and Meta-Analysis

Background: Developmental dyslexia (DD) is a specific learning disorder concerning reading acquisition that may has a lifelong negative impact on individuals. A reliable estimate of the prevalence of DD serves as the basis for diagnosis, intervention, and evidence-based health resource allocation and policy-making. Hence, the present meta-analysis aims to generate a reliable prevalence estimate of DD worldwide in primary school children and explore the potential variables related to that prevalence. Methods: Studies from the 1950s to June 2021 were collated using a combination of search terms related to DD and prevalence. Study quality was assessed using the STROBE guidelines according to the study design, with study heterogeneity assessed using the I2 statistic, and random-effects meta-analyses were conducted. Variations in the prevalence of DD in different subgroups were assessed via subgroup meta-analysis and meta-regression. Results: The pooled prevalence of DD was 7.10% (95% CI: 6.27–7.97%). The prevalence in boys was significantly higher than that in girls (boys: 9.22%, 95%CI, 8.07–10.44%; girls: 4.66%, 95% CI, 3.84–5.54%; p < 0.001), but no significant difference was found in the prevalence across different writing systems (alphabetic scripts: 7.26%, 95%CI, 5.94–8.71%; logographic scripts: 6.97%, 95%CI, 5.86–8.16%; p > 0.05) or across different orthographic depths (shallow: 7.13%, 95% CI, 5.23–9.30%; deep: 7.55%, 95% CI, 4.66–11.04%; p > 0.05). It is worth noting that most articles had small sample sizes with diverse operational definitions, making comparisons challenging. Conclusions: This study provides an estimation of worldwide DD prevalence in primary school children. The prevalence was higher in boys than in girls but was not significantly different across different writing systems.

Remote Dyslexia Screening for Bilingual Children

Ideally, language and reading skills in bilingual children are assessed in both languages spoken in order to avoid misdiagnoses of communication or learning disorders. Due to limited capacity of clinical and educational staff, computerized screenings that allow for automatic evaluation of the children’s performance on reading tasks (accuracy and speed) might pose a useful alternative in clinical and school settings. In this study, a novel web-based screening platform for language and reading assessment is presented. This tool has been preliminarily validated with monolingual Italian, Mandarin–Italian and English–Italian speaking primary school children living and schooled in Italy. Their performances in the screening tasks in Italian and—if bilingual—in their native language were compared to the results of standardized/conventional reading assessment tests as well as parental and teacher questionnaires. Correlations revealed the tasks that best contributed to the identification of risk for the presence of reading disorders and showed the general feasibility and usefulness of the computerized screening. In a further step, both screening administrators (Examiners) and child participants (Examinees) were invited to participate in usability studies, which revealed general satisfaction and provided suggestions for further improvement of the screening platform. Based on these findings, the potential of the novel web-based screening platform is discussed.

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

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

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.

ERP Correlates of Altered Orthographic-Phonological Processing in Dyslexia

Automatic visual word recognition requires not only well-established phonological and orthographic representations but also efficient audio-visual integration of these representations. One possibility is that in developmental dyslexia, inefficient orthographic processing might underlie poor reading. Alternatively, reading deficit could be due to inefficient phonological processing or inefficient integration of orthographic and phonological information. In this event-related potential study, participants with dyslexia (N = 25) and control readers (N = 27) were presented with pairs of words and pseudowords in an implicit same-different task. The reference-target pairs could be identical, or different in the identity or the position of the letters. To test the orthographic-phonological processing, target stimuli were presented in visual-only and audiovisual conditions. Participants with and without dyslexia processed the reference stimuli similarly; however, group differences emerged in the processing of target stimuli, especially in the audiovisual condition where control readers showed greater N1 responses for words than for pseudowords, but readers with dyslexia did not show such difference. Moreover, after 300 ms lexicality effect exhibited a more focused frontal topographic distribution in readers with dyslexia. Our results suggest that in developmental dyslexia, phonological processing and audiovisual processing deficits are more pronounced than orthographic processing deficits.

Reading and spelling disorders in a school-based population screening in Sicily (Italy)

This research was carried out according to the Italian Consensus Conference on Specific Learning Disability guidelines for screening initiatives. It describes a three-year screening project involving 2.469 students, aged 8-15 years, from various classes of primary, lower and upper secondary schools of Sicily. Students were assessed for reading and spelling skills. Overall, 4.9% met the risk criteria for suspected reading disorder, 6.1% for spelling disorder, while 8.5% for both conditions. Results showed that out of 932 pupils in the primary school, 4.6% met the risk criteria for reading disorder and 6.5% for spelling disorder; out of 855 pupils of the lower secondary school, 5.3% for reading disorder and 5.5% for spelling disorder; out of 652 pupils of the upper secondary school, 4.9% for reading disorder and 6.1% for spelling disorder. No significant difference in the prevalence of students at risk of reading disorder or spelling disorder, within the three grade-levels over 3 years, was found. At project conclusion further clinical investigation to verify the screening results on student sub-sample (57%) was carried out. The percentage of students with SLD was equal to 3.15%, in the primary school, 3.76% in the lower secondary school and 2.51%, in the upper secondary school.

Comparison on Well-Being, Engagement and Perceived School Climate in Secondary School Students with Learning Difficulties and Specific Learning Disorders: An Exploratory Study

Reading and writing skills influence the social status of students, exerting effects not only on learning, but also on wellbeing. This study aimed to assess the impact of diagnosis of specific learning disorder on well-being in secondary-school students, comparing students with a diagnosis of specific learning disorder (SLD-group), students showing learning difficulties without diagnosis (LD-group) and students without learning difficulties (control-group). Students were tested with neuropsychological screening tests in order to identify learning difficulties and were further assessed by means of psychological and school well-being questionnaires. The results show that LD group perceive themselves as having a low sense of mastery and autonomy, less interest and engagement in daily activities and low peer social support than their schoolmates. This result highlights, for the LD group, a low well-being experience, which is not observed in the SLD and control groups. On the contrary, SLD group students do not differ from control group students in any dimensions except for the perceived parents' support and involvement in school life, in which the SLD group show the highest scores. This work underlines the importance of having a diagnosis as it seems to work as a protective factor for both the psychological and school well-being of the student.

Two aspects of psychological functioning in undergraduates with a history of reading difficulties: anxiety and self-efficacy

Reading difficulties have been associated with problems in psychological functioning, including challenges in both anxiety and self-efficacy. This study was designed to determine whether such psychological functioning problems are specific to the academic sphere or more global. First-year undergraduate students with and without a history of reading difficulties (n = 40 and 46, respectively) completed standardized questionnaires on general and academic anxiety, and social and academic self-efficacy. Students with a history of reading difficulties reported higher academic anxiety, but comparable general anxiety, relative to those with no such history. Students with a history of reading difficulties also reported lower academic self-efficacy, but comparable social self-efficacy, relative to those with no such history. These findings suggest that students with a history of reading difficulties, as compared to those without such history, experience academic-specific mental health symptoms involving heightened anxiety and low self-efficacy as they enter university. These results point to the need for focused and targeted assessments to be able to capture difficulties they experience with anxiety and self-efficacy and interventions to help them cope with these difficulties. More broadly, the findings have implications for how universities assess academic vulnerabilities and provide access to specific course accommodations.

The Computerized Adaptable Test Battery (BMT-i) for Rapid Assessment of Children's Academic Skills and Cognitive Functions: A Validation Study

Background: Learning disabilities in children are a major public health concern worldwide, having a prevalence of 8%. They are associated with lost social, educational, and ultimately, professional opportunities for individuals. These disabilities are also very costly to governments and raise the issue of the appropriate means of screening. Unfortunately, validated tools for preliminary appraisal of learning and cognitive function in struggling children are presently restricted to specific age ranges and cognitive domains. This study sought to validate a first-line battery for assessment of academic skills and cognitive functions. Materials and Methods: The computerized Adaptable Test Battery, or BMT-i, includes a panel of tests for the first-line assessment of children's academic skills and cognitive functions. The tests reflect expected abilities for the age group in question, exploring academic skills (written language and mathematical cognition) and cognitive domains (verbal, non-verbal, and attentional/executive functions). The authors relied on the results of these tests for a sample of 1,074 Francophone children representative of the mainland French school-age population (522 boys and 552 girls, ages 4-13, from 39 classes at 7 public and 5 private schools). Thirteen speech-language pathologists and neuropsychologists individually administered the tests. Results: The psychometric characteristics of the empirical data obtained showed acceptable to good test homogeneity, internal consistency (Cronbach's alpha: > 0.70), test-retest reliability (intraclass correlation coefficients: ~0.80), and consistency with reference test batteries (r: 0.44-0.96). Conclusion: The BMT-i was validated in a large sample of children in mainstream French schools, paving the way for its use in first-line screening of learning disabilities among children with complaints, whether their learning difficulties have been flagged by their parents or by their teachers.

Learning Abilities in a Population of Italian Healthy Preterm Children at the End of Primary School

Background: Delays in learning skills have been extensively reported for very preterm children. However, few studies have examined academic achievement profiles in Italian preterm children as a function of their neonatal immaturity. Methods: A cross-sectional study was performed that included 82 healthy Italian children born very and extremely preterm (without major neurosensory outcomes; IQ ≥85). Children were evaluated for academic and neurocognitive performances at the second cycle of primary school. Results: Healthy preterm children showed on average academic and neurocognitive profiles that did not differ according to gestational age. Impairment was seen to one or more learning domains in 14.6% of the healthy preterm children. Conclusions: Italian children born very and extremely preterm without major neurosensory damage and/or cognitive delay showed on average learning and neurocognitive profiles within the normal range, regardless of gestational age. Nevertheless, they showed higher proportions of learning impairment than a normative Italian population during their final years of primary school. Healthcare providers should be aware of this result, and long-term surveillance should be organized to promptly identify those children who are in need of therapeutic intervention.

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.

Inter-letter spacing, inter-word spacing, and font with dyslexia-friendly features: testing text readability in people with and without dyslexia

Over the last years, several studies have suggested a possible link between dyslexia and deficits in low-level visual processing (e.g., excessive crowding). At the same time, specially designed "dyslexia-friendly" fonts appeared on the market. This class of fonts presents two main features: the particular graphic characteristics of the letterform designed to avoid confusion between similarly shaped letters, and wider inter-letter and inter-word spacing to limit crowding. The literature testing the efficacy of "dyslexia-friendly" fonts in improving reading accuracy and increasing reading speed is controversial. We evaluated the impact of letterform (with vs. without dyslexia-friendly graphic features), inter-letter spacing (standard vs. increased), and inter-word spacing (standard vs. increased) on reading accuracy and speed. Two groups of 64 children each, with and without dyslexia, read aloud 8 equivalent texts. The data collected failed to show any effect from the letterform. As regards spacing, the data showed that reading speed is impaired by an increase in inter-letter spacing not combined with an adequate increase in inter-word spacing.