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Understanding Dyslexia -      For Students  

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Understanding Dyslexia -      For Students  

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Dyslexia: 10 Classroom Indicators - Nessy US

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10 Classroom Warning Signs of Dyslexia. Dyslexia usually becomes more prominent in school when there is a focus on a child's ability to read and write.

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Ted Talk

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The True Gifts of a Dyslexic Mind | Dean Bragonier | TEDxMarthasVineyard

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Ted Talk

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What is dyslexia? - Kelli Sandman-Hurley

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Dyslexia and Intelligence - Is there a connection?

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Functional disruption in the organization of the brain for reading in dyslexia

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Functional disruption in the organization of the brain for reading in dyslexia

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Introduction

Auditory processing disorder (APD) is suspected when a child presents with unexplained listening difficulties. The primary feature is difficulty hearing in background noise despite a normal audiogram. APD is widely diagnosed in the USA and Australia, and is beginning to receive more attention in the UK and elsewhere.

There is, however, debate over the validity and reliability of commonly used APD assessments, definition of APD and possible misidentification of learning problems as APD. It has been suggested that APD is not a separate disorder but rather is a reflection of an attention deficit, a learning disability or a language disorder.

It has been suggested that the diagnosis a child receives is partly dependent on the professional who assesses them. In other words, an audiologist would diagnose APD in cases where an educational psychologist or speech therapist would diagnose dyslexia or specific language impairment (SLI). Note that auditory processing problems may co-occur with specific learning disabilities, and some have suggested that they may be causally related. The significance of auditory processing difficulties is one that has been widely researched and remains controversial. In this study, we focused on whether the psychometric profile of children with an APD diagnosis differed from that of children with dyslexia. During an initial assessment, all participating children completed a detailed psychometric battery comprising standardised assessment and parent report measures. On the basis of our findings, a follow-up assessment focusing on a screening assessment of autistic features was conducted with a subset of children from both APD and dyslexia groups.

▶ Auditory processing disorder (APD) is diagnosed on the basis of listening difficulties and poor performance on tests of auditory processing despite a normal audiogram. There is debate over whether APD is a separate diagnostic entity in its own right with a distinctive psychometric profile, or whether it is a reflection of a more general learning disability.

▶ Children with a diagnosis of APD have high levels of attentional, reading and language difficulties. A substantial minority may also have autistic features. These children are therefore likely to benefit from evaluation by a multidisciplinary team.

Results

APD and dyslexia groups did not differ in age (means of 10.4 years, SD 2.5 and 10.1 years, SD 1.6 respectively, t(42)=−0.48, p>0.05). There was a higher proportion of males in the dyslexia group (17/19 cases) than in the APD group (15/25 cases), Fisher p=0.04. The two groups were not significantly different in non-verbal IQ (M=98.7, SD 14.8 and M=102.2, SD 11.4, respectively for APD and dyslexia groups, t(42)=0.86, p>0.05).

Comorbid conditions

Rates of dyslexia, SLI as well as attentional and auditory processing problems were examined in the APD and dyslexia groups. Dyslexia criteria were as used for dyslexia group selection. SLI was defined as a non-verbal IQ of 80 or better and performance on two or more out of six language tests (TROG, NEPSY sentence repetition, NEPSY non-word repetition, ERRNI storytelling, ERRNI MLU, ERRNI story comprehension) below −1 SD. Around half (13 of 25, 52%) of APD children would also fit a diagnosis of either SLI, dyslexia or both. A relatively high proportion of children in the dyslexia group would also fit a diagnosis of SLI (11 of 19, 58%). The proportion of children who fit a diagnosis of SLI was not statistically significantly different between the APD group and the dyslexia group (Fisher p=0.36).

Hyperactivity/inattention was identified using recommended cut-off scores for the parent-completed SDQ and classifications according to 'normal,' 'borderline' and 'abnormal' cases. Around 10% of the general population would be expected to score in the 'abnormal' range, with an additional 10% in the 'borderline' range. The proportion of abnormal cases was 37% and 46% for the dyslexia and APD groups, respectively. The proportion of abnormal and borderline cases combined was around 50% for both dyslexia and APD groups, not statistically significantly different from each other (Fisher p=1.00).

Prevalence of possible auditory processing problems was defined by SCAN test results. In an earlier study, we found UK children scored significantly worse than US norms on the SCAN-C. We therefore computed standard scores from our own UK norms (99 UK schoolchildren aged 6-10 for the SCAN-C and 11 adults for the SCAN-A). Performance was then categorised as recommended in the SCAN manuals; a composite standard score better than −1 SD is 'normal,' between −1 and −2 SD is 'borderline,' and lower than −2 SD is 'disordered.'

Using UK norms, 40% (10 of 25) of the APD group and 22% (four of 18) of the dyslexia group scored within the 'borderline' or 'disordered' range. These proportions were not statistically significantly different (Fisher p=0.32). One would expect around 16% of a random sample to score in this range. Note that a surprisingly low proportion of the APD group scored in the clinical range on the SCAN, given that their original diagnosis was partially based upon SCAN performance. The reasons for this are discussed in detail elsewhere. Briefly, the main reasons are as follows: (1) use of inappropriate US-based norms with UK children and (2) original diagnosis of APD on the basis of poor performance on at least one of four SCAN subtests rather than on the total score, a practice that inflates type 1 error and positive identification of APD.

Group comparisons

Group performance on standardised tests was examined via analysis of variance (ANOVA). Results are reported in the form of composite scores for language and literacy. The 'language composite' score is an average of the standard scores of six language tests (TROG, NEPSY non-word and sentence repetition, ERRNI story telling, MLU and comprehension). The 'literacy composite' is the average of the standard scores of three literacy tests (OSCCI spelling, TOWRE word and non-word reading). The mean composite scores are shown in . Unsurprisingly, as the group was selected on the basis of poor literacy skills, the dyslexic group did significantly worse on the literacy composite, although both groups' average literacy score was below −1 SD. Groups did not differ significantly on language composite or SCAN composite score.

Table 1

For parent-completed questionnaires, the APD group scored worse on the CHAPS listening behaviours questionnaire. There was no difference in overall CCC-2 general communication composite (GCC) score. An ANOVA was carried out to compare the average score on each CCC-2 subscale between groups. Both groups scored similarly low on speech, syntax and semantics (an average subscale score is 10 with SD 3, shown in by a dotted line). After adjusting for multiple comparisons (p<0.005), there were no significant differences between groups on any subscale. 'Use of context,' 'non-verbal,' 'social' and 'interests' subscales were approaching significance (p=0.02-0.06). These subscales are associated with autistic spectrum disorders. Overall, both structural language and pragmatic problems were a feature of children with suspected APD.

Discrepancy between parental report and standardised tests

During evaluation of individual test results, it was noticed that parents of APD participants tended to rate their children less well on the CCC-2 than their child's performance on standardised language tests would suggest. This tendency was examined statistically. GCCs from the CCC-2 were converted to standard scores for comparison with the standardised language composite to have a mean of 100 and a SD of 15. The magnitude of the discrepancy between parental communication checklist and standardised language test was then calculated as the language composite minus the standardised total CCC-2 score (DISCREP). There was a group difference in the magnitude of the average discrepancy score, with the APD group significantly higher (APD M=24.32, SD 11.99, dyslexia M=16.88, SD 11.29, t(41)=−2.10 p<0.05, r=0.31).

One possibility that may explain the discrepancy between parent report of poor communicative competence and relatively good standardised test performance is that while these children may have a relatively good structural language, they have difficulties using language appropriately and effectively in more demanding communicative situations. CCC-2 subscales on which group differences were approaching significance were associated with autistic spectrum disorders, with the APD group being rated worse on these pragmatic subscales (though non-significant after correction for multiple comparisons).

This raised the question of some children with a diagnosis of APD having unidentified autism spectrum disorders, leading us to obtain approval from the NHS Ethics Committee to obtain additional information from the CAST, 6-8 months after the initial study. Valid CAST questionnaires were received from the parents of 12 dyslexia and 18 APD participants. Average CAST raw scores were significantly higher in the APD group than in the dyslexia group (11.1 SD 5.5 vs 5.2 SD 2.3, t(28)=−3.4, p<0.01, r=0.54). The recommended cut-off score for identification of possible clinical cases is 15. Applying this criterion yielded six cases within the APD group (33%) and no cases within the dyslexia group. This difference was marginally non-significant (Fisher p=0.06, two-sided). There was no correlation between DISCREP and CAST raw score (r=0.27, NS).

Discussion

We were interested in whether children diagnosed as having APD have a distinctive pattern of psychometric performance, and whether the pattern differed from that of children with dyslexia. Around half of the children diagnosed as having APD would fit a diagnosis of dyslexia or SLI or both. Conversely, the dyslexia group scored similarly to the APD group on the SCAN test of auditory processing. A high prevalence of attention/hyperactivity problems was also a feature of both groups. While there was a trend for the APD group to do worse than the dyslexia group on all the behavioural measures, the only significant difference in performance between groups was on literacy measures, where the dyslexia group, who had been selected on this basis, did worse. Average literacy scores for the APD group were also poor. In terms of severity of attentional, reading, language and auditory processing skills, the difference between APD and dyslexia children is quantitative rather than qualitative, with APD diagnosed children tending to have more severe problems.

One characteristic that did distinguish between these two groups was that in the APD group, there was an unusual discrepancy (DISCREP) between parental ratings of poor communicative competence or listening behaviours and standardised test performance (standardised language tests and the CCC-2, and the CHAPS and the SCAN). We considered the possibility that this might indicate that children who receive a diagnosis of APD have elevated levels of autistic features, since pragmatic difficulties are often not detected on formal psychometric tests. The average score on a parental report screening test for ASD (the CAST) was significantly higher in the APD group than in the dyslexia group. Thirty-three per cent of the APD group (six children) scored above the clinical cut-off on the CAST. Asperger syndrome had been formally diagnosed for only one of the six APD children who scored in the clinical range on the CAST.

This result is consistent with an earlier study based on case records, which found that 9% of referrals to a specialist APD clinic had a formal diagnosis of autism. Furthermore, unusual sensory sensitivity is associated with autistic disorders, and children with autism have been described as being indifferent to some sounds, such as ignoring someone calling their own name, while also being hypersensitive to sounds, such as hearing sounds that others cannot or exhibiting extreme aversive reactions to innocuous sounds.

In summary, children diagnosed as having APD did not differ qualitatively from those with dyslexia in their performance on psychometric tests of IQ, auditory processing, language or literacy, though there was a tendency for children with APD to perform worse across all measures. In contrast to those with dyslexia, children with APD showed a discrepancy between parent report of poor communicative competence and relatively good performance on standardised language tests. We suggest that pragmatic problems associated with autistic spectrum disorder, to which standardised tests are largely insensitive, may partially explain this discrepancy. The most striking finding was that a third of children with an APD diagnosis fell within the clinical range on a screening questionnaire for Asperger syndrome, though ASD had not been formally recognised for most of these cases. This finding deserves further investigation with a larger sample of children with suspected APD. It may be useful to screen children referred to APD clinics for 'listening difficulties' for communication problems associated with unrecognised ASD. Effective management might then centre on remediating these children's pragmatic difficulties. Many children with APD do have demonstrable learning problems, though it is unclear to what extent their reported listening problems are due to actual difficulties with auditory processing, language difficulties or ASD.

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Psychometric profile of children with auditory processing disorder and children with dyslexia

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Auditory processing disorder (APD) is suspected when a child presents with unexplained listening difficulties. The primary feature is difficulty hearing in background noise despite a normal audiogram. APD is widely diagnosed in the USA and Australia, and is beginning to receive more attention in the UK and elsewhere.

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Critical Acclaim

"[Maryanne Wolf] displays extraordinary passion and perceptiveness concerning the reading brain, its miraculous achievements and tragic dysfunctions." -BookForum

"Everything Wolf says makes sense....She clearly knows her stuff." -Washington Post Book World

"Brilliant and eye-opening." -Albany Times Union

"...intriguing..." -New Scientist

"Fascinating....Wolf restores our awe of the human brain." -Associated Press

"[Wolf's] conversational style, reflective comments and insights from work with children...create a narrative flow and bright tone." -Minneapolis Star Tribune

"The squid of Wolf's title represents the neurobiological approach to the study of reading....Given the panic that takes hold of humanists when the decline of reading is discussed, her cold-blooded perspective is opportune." -The New Yorker

"A book worth talking about." -U.S. News & World Report

"Enjoyable....Wolf, with remarkable agility in a relatively compact book (intended for both aficionados and the uninitiated), transitions seamlessly between disciplines as diverse as linguistics, neuroscience, cognitive psychology, and archeology, among others. Her voice comes through clearly; she is fascinated by reading and shares that energy." -New England Journal of Medicine

"Wolf's alarm about the spread of semi- literacy among the young is obviously justified, and her book provokes thought about it as only reading can." -Sunday Times (London)

"This humane and fascinating book...is a paean to what Proust, über-reader, called 'that fruitful miracle of a communication in the midst of solitude,' to all that has been and can be achieved for individuals and for mankind through literacy." -The Evening Standard (London)

"Blindingly fascinating...detailed and scholarly....There's a lot of difficult material in here. But it's worth the effort....For people interested in language, this is a must. You'll find yourself focusing on words in new ways. Read it slowly--it will take time to sink in." -The Sunday Telegraph

"Proust and the Squid is an inspiring celebration of the science of reading....Wolf's insights are fascinating....Proust and the Squid has much to offer on this important--perhaps the most important--subject" -The Guardian (London)
Reviews of Proust and the Squid also appeared in:
The Sunday Times (London) ~ The Evening Standard (London) ~ Sunday Telegraph (London)
La Repubblica (Italy)
Suddeutsche Zeitung ~Der Spiegel ~Frankfurter Allgemeine Zeitung (Germany)
Philadelphia Inquirer Orton Gillingham Report ~ Norfolk Portfolio ~ Eldorado Journal/Harrisburg Register ~ Publishers Weekly ~ Minnesota Star Tribute ~ Washington Post ~ San Francisco Chronicle ~ Oregonian

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Proust and the Squid: The Story and Science of the Reading Brain - Maryanne Wolf

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Proust and the Squid: The Story and Science of the Reading Brain