Achievement Gap in Reading Is Present as Early as First Grade and Persists through Adolescence.

OBJECTIVES: To determine if differences between dyslexic and typical readers in their reading scores and verbal IQ are evident as early as first grade and whether the trajectory of these differences increases or decreases from childhood to adolescence. STUDY DESIGN: The subjects were the 414 participants comprising the Connecticut Longitudinal Study, a sample survey cohort, assessed yearly from 1st to 12th grade on measures of reading and IQ. Statistical analysis employed longitudinal models based on growth curves and multiple groups. RESULTS: As early as first grade, compared with typical readers, dyslexic readers had lower reading scores and verbal IQ, and their trajectories over time never converge with those of typical readers. These data demonstrate that such differences are not so much a function of increasing disparities over time but instead because of differences already present in first grade between typical and dyslexic readers. CONCLUSIONS: The achievement gap between typical and dyslexic readers is evident as early as first grade, and this gap persists into adolescence. These findings provide strong evidence and impetus for early identification of and intervention for young children at risk for dyslexia. Implementing effective reading programs as early as kindergarten or even preschool offers the potential to close the achievement gap.

Early reading at first grade predicts adult reading at age 42 in typical and dyslexic readers.

Research indicates that the achievement gap in reading between typical and dyslexic readers is already evident in first grade and persists through adolescence. However, it is not known whether this reading gap persists into adult life. In this report we use an epidemiologic sample of 312 children (typical readers = 246; dyslexic readers = 66), followed longitudinally from age 5 through adulthood and examine two fundamental questions: 1) Is reading level in 1st grade predictive of reading proficiency in adulthood in typical and dyslexic readers? and 2) Are the trajectories of reading development from 1st through 5th grade predictive of reading proficiency in adulthood in typical and dyslexic readers? Our findings indicate that early reading levels in 1st grade as well as the trajectory of reading development through the first five years of school were associated with reading scores in adulthood. This association was stronger for dyslexic than for typical readers, especially the latter factor. These findings indicate that the achievement gap between typical and dyslexic readers persists far beyond adolescence, in fact, into adult life.

Prevalence of undiagnosed dyslexia in African-American primary school children.

Dyslexia is among the most common neurodevelopmental disorders in children, yet despite its high prevalence all too frequently goes undiagnosed. Consequently dyslexic children all too often fail to receive effective reading interventions. Here we report our findings from a study using a teacher completed evidence-based dyslexia screener to first screen then test predominantly African-American children in grades kindergarten through second grade in two inner city public charter schools in New Orleans. Almost half (49.2%) of the children screened as at risk for dyslexia and of these the majority were found to be dyslexic on more detailed testing. Our results suggest that large numbers of African-American students with dyslexia may be overlooked in schools.

Dyslexia in the 21st century.

PURPOSE OF REVIEW: Within the past decade tremendous advances have occurred in our understanding of dyslexia. RECENT FINDINGS: Reliable data now validate the definition of dyslexia as an unexpected difficulty in reading in an individual who has the ability to be a much better reader. That dyslexia is unexpected is now codified in US federal law (PL 115-391). Replicated studies using functional brain imaging have documented a neural signature for dyslexia. Epidemiologic, longitudinal data now demonstrate that dyslexia is highly prevalent, affecting 20% of the population, affecting boys and girls equally. These data further demonstrate that the achievement gap between dyslexic and typical readers is now evident as early as first grade and persists. Evidence-based, efficient, inexpensive screening tools now offer the possibility of universal screening to identify children at risk for dyslexia as early as first grade. Specialized schools which focus on dyslexic students provide welcoming communities, ensuring that dyslexic children will not only survive but thrive. SUMMARY: Taken together, these findings indicate that we must act and act now to ensure that this 21st century knowledge of dyslexia is disseminated to educators, policy makers, and most of all to parents of dyslexic children.

Uncoupling of reading and IQ over time: empirical evidence for a definition of dyslexia.

Developmental dyslexia is defined as an unexpected difficulty in reading in individuals who otherwise possess the intelligence and motivation considered necessary for fluent reading, and who also have had reasonable reading instruction. Identifying factors associated with normative and impaired reading development has implications for diagnosis, intervention, and prevention. We show that in typical readers, reading and IQ development are dynamically linked over time. Such mutual interrelationships are not perceptible in dyslexic readers, which suggests that reading and cognition develop more independently in these individuals. To our knowledge, these findings provide the first empirical demonstration of a coupling between cognition and reading in typical readers and a developmental uncoupling between cognition and reading in dyslexic readers. This uncoupling was the core concept of the initial description of dyslexia and remains the focus of the current definitional model of this learning disability.

Developmental trajectories of white matter structure in children with and without reading impairments.

Left temporal-parietal white matter structure is consistently associated with reading abilities in children. A small number of longitudinal studies show that development of this area over time is altered in children with impaired reading. However, it remains unclear how brain developmental patterns relate to specific reading skills such as fluency, which is a critical part of reading comprehension. Here, we examined white matter development trajectories in children with dysfluent reading (20 dysfluent and inaccurate readers, 36 dysfluent and accurate readers) compared to non-impaired readers (n = 14) over 18 months. We found typical age-related increases of fractional anisotropy (FA) in bilateral temporal-parietal areas in non-impaired readers, but a lack of similar changes in dysfluent readers. We also found steeper decreases of mean diffusivity (MD) in the right corona radiata and left uncinate fasciculus in dysfluent inaccurate readers compared to dysfluent accurate readers. Changes in diffusion parameters were correlated with changes in reading scores over time. These results suggest delayed white matter development in dysfluent readers, and show maturational differences between children with different types of reading impairment. Overall, these results highlight the importance of considering developmental trajectories, and demonstrate that the window of plasticity may be different for different children.

Paying attention to reading: the neurobiology of reading and dyslexia.

Extraordinary progress in functional brain imaging, primarily advances in functional magnetic resonance imaging, now allows scientists to understand the neural systems serving reading and how these systems differ in dyslexic readers. Scientists now speak of the neural signature of dyslexia, a singular achievement that for the first time has made what was previously a hidden disability, now visible. Paralleling this achievement in understanding the neurobiology of dyslexia, progress in the identification and treatment of dyslexia now offers the hope of identifying children at risk for dyslexia at a very young age and providing evidence-based, effective interventions. Despite these advances, for many dyslexic readers, becoming a skilled, automatic reader remains elusive, in great part because though children with dyslexia can be taught to decode words, teaching children to read fluently and automatically represents the next frontier in research on dyslexia. We suggest that to break through this "fluency" barrier, investigators will need to reexamine the more than 20-year-old central dogma in reading research: the generation of the phonological code from print is modular, that is, automatic and not attention demanding, and not requiring any other cognitive process. Recent findings now present a competing view: other cognitive processes are involved in reading, particularly attentional mechanisms, and that disruption of these attentional mechanisms play a causal role in reading difficulties. Recognition of the role of attentional mechanisms in reading now offer potentially new strategies for interventions in dyslexia. In particular, the use of pharmacotherapeutic agents affecting attentional mechanisms not only may provide a window into the neurochemical mechanisms underlying dyslexia but also may offer a potential adjunct treatment for teaching dyslexic readers to read fluently and automatically. Preliminary studies suggest that agents traditionally used to treat disorders of attention, particularly attention-deficit/hyperactivity disorder, may prove to be an effective adjunct to improving reading in dyslexic students.

Identifying atypical change at the individual level from childhood to adolescence.

Identifying change at the individual level is an important goal for researchers, educators, and clinicians. We present a set of statistical procedures for identifying individuals who depart from a normative change. Using Latent Change Scores models (LCS), we illustrate how the Individual Likelihood computed from a statistical model for change (IL) and from an alternative unrestricted model (ILsat) can be used to identify atypical trajectories in situations with several measurement occasions. Using LCS and linear regression, we also show how the observed and latent change residuals can be used to identify atypical individual change between 2 measurement occasions. We apply these methods to a measure of general verbal ability (from WISC-R), from a large sample of individuals assessed every 2 years from Grade 1 to 9. We demonstrate the efficiency of these techniques, illustrate their use to identify individual change in longitudinal data, and discuss potential applications in developmental research. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Error-related event-related potentials in children with attention-deficit hyperactivity disorder, oppositional defiant disorder, reading disorder, and math disorder.

We studied error-related negativity (ERN) and error positivity (Pe) during a discrimination task in 319 unmedicated children divided into subtypes of ADHD (Not-ADHD/inattentive/combined), learning disorder (Not-LD/reading/math/reading+math), and oppositional defiant disorder. Response-locked ERPs contained a frontocentral ERN and posterior Pe. Error-related negativity and positivity exhibited larger amplitude and later latency than corresponding waves for correct responses matched on reaction time. ADHD did not affect performance on the task. The ADHD/combined sample exceeded controls in ERN amplitude, perhaps reflecting patients' adaptive monitoring efforts. Compared with controls, subjects with reading disorder and reading+math disorder performed worse on the task and had marginally more negative correct-related negativities. In contrast, Pe/Pc was smaller in children with reading+math disorder than among subjects with reading disorder and Not-LD participants; this nonspecific finding is not attributable to error processing. The results reflect anomalies in error processing in these disorders but further research is needed to address inconsistencies in the literature.

Longitudinal models of developmental dynamics between reading and cognition from childhood to adolescence.

The authors applied linear dynamic models to longitudinal data to examine the dynamics of reading and cognition from 1st to 12th grade. They used longitudinal data (N=445) from the Connecticut Longitudinal Study (S. E. Shaywitz, B. A. Shaywitz, J. M. Fletcher, & M. D. Escobar, 1990) to map the dynamic interrelations of various scales of the Wechsler Intelligence Scales for Children--Revised (i.e., Full, Performance, and Verbal) and specific markers of the Woodcock-Johnson Psycho-Educational Battery--Revised reading cluster (i.e., Letter-Word ID, Decoding, and Comprehension). The results of these analyses indicate that (a) there is a positive dynamic relation between reading and cognition across the selected age range; (b) this dynamic relation is symbiotic, with positive influences in both directions; (c) the influence from cognition to reading is stronger when considering the Wechsler Intelligence Scales for Children Performance--Revised Performance scale and weaker with the Verbal scale; (d) when examining the different Reading subtests, the influences from cognition are more apparent for Letter-Word ID and Comprehension and are less perceptible for Decoding; and (e) the dynamics of reading and cognition appear to be of stronger magnitude during 1st to 3rd grade, less strong during 4th to 8th grade, and weaker from 9th to 12th grade.

Management of dyslexia, its rationale, and underlying neurobiology.

Developmental dyslexia is characterized by an unexpected difficulty in reading in children and adults who otherwise possess the intelligence and motivation considered necessary for accurate and fluent reading. Dyslexia is the most common and most carefully studied of the learning disabilities, affecting 80% of all individuals identified as learning disabled. Although in the past the diagnosis and implications of dyslexia were often uncertain, recent advances in the knowledge of the epidemiology, the neurobiology, the genetics, and the cognitive influences on the disorder now allow the disorder to be approached within the framework of a traditional medical model. This article reviews these advances and their implications for the approach to patients presenting with a possible reading disability.

Effect of Atomoxetine Treatment on Reading and Phonological Skills in Children with Dyslexia or Attention-Deficit/Hyperactivity Disorder and Comorbid Dyslexia in a Randomized, Placebo-Controlled Trial.

OBJECTIVES: Evaluated the effects of atomoxetine on the reading abilities of children with dyslexia only or attention-deficit/hyperactivity disorder (ADHD) and comorbid dyslexia. METHODS: Children aged 10-16 years (N = 209) met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria for dyslexia only (n = 58), ADHD and comorbid dyslexia (n = 124), or ADHD only (n = 27) and were of normal intelligence. Patients were treated with atomoxetine (1.0-1.4 mg/kg/day) or placebo in a 16-week, randomized, placebo-controlled, double-blind trial. The dyslexia-only and ADHD and comorbid dyslexia groups were randomized 1:1; the ADHD-only group received atomoxetine in a blinded manner. Reading abilities were measured with the Woodcock Johnson III (WJIII), Comprehensive Test of Phonological Processing (CTOPP), Gray Oral Reading Tests-4, and Test of Word Reading Efficiency. RESULTS: Atomoxetine-treated dyslexia-only patients compared with placebo patients had significantly greater improvement (p < 0.02) with moderate to approaching high effect sizes (ES) on WJIII Word Attack (ES = 0.72), Basic Reading Skills (ES = 0.48), and Reading Vocabulary (ES = 0.73). In the atomoxetine-treated ADHD and comorbid dyslexia group, improvement on the CTOPP Elision measure (ES = 0.50) was significantly greater compared with placebo (p < 0.02). Total, inattentive, and hyperactive/impulsive ADHD symptom reductions were significant in the atomoxetine-treated ADHD and comorbid dyslexia group compared with placebo, and from baseline in the ADHD-only group (p ≤ 0.02). ADHD symptom improvements in the ADHD and comorbid dyslexia group were not correlated with improvements in reading. CONCLUSIONS: Atomoxetine treatment improved reading scores in patients with dyslexia only and ADHD and comorbid dyslexia. Improvements for patients with dyslexia only were in critical components of reading, including decoding and reading vocabulary. For patients with ADHD and comorbid dyslexia, improvements in reading scores were distinct from improvement in ADHD inattention symptoms alone. These data represent the first report of improvements in reading measures following pharmacotherapy treatment in patients with dyslexia only evaluated in a randomized, double-blind trial.

The role of functional magnetic resonance imaging in understanding reading and dyslexia.

Converging evidence from a number of lines of investigation indicates that dyslexia represents a disorder within the language system and more specifically within a particular subcomponent of that system, phonological processing. Recent advances in imaging technology, particularly the development of functional magnetic resonance imaging (fMRI), provide evidence of a neurobiological signature for dyslexia, specifically a disruption of 2 left hemisphere posterior brain systems, 1 parietal-temporal, the other occipital-temporal, with compensatory engagement of anterior systems around the inferior frontal gyrus and a posterior (right occipital-temporal) system. Furthermore, good evidence indicates a computational role for the left occipital-temporal system: the development of fluent (automatic) reading. In addition, fMRI studies of young adults with reading difficulties followed prospectively and longitudinally from age 5 through their mid 20s suggests that there may be 2 types of reading difficulties, 1 primarily reflecting a genetic basis, the other, and far more common, reflecting environmental influences. The brain systems for reading are malleable and their disruption in children with dyslexia may be remediated by provision of an evidence-based, effective reading intervention. These studies offer the promise for more precise identification and effective management of dyslexia in children, adolescents, and adults.

How Should Medical Schools Respond to Students with Dyslexia?

We examine the dilemmas faced by a medical student with dyslexia who wonders whether he should "out" himself to faculty to receive the accommodations entitled by federal law. We first discuss scientific evidence on dyslexia's prevalence, unexpected nature, and neurobiology. We then examine the experiences of medical students who have revealed their dyslexia to illustrate the point that, far too often, attending physicians who know little about dyslexia can misperceive the motives or behavior of students with dyslexia. Because ignorance and misperception of dyslexia can result in bias against students with dyslexia, we strongly recommend a mandatory course for faculty that provides a basic scientific and clinical overview of dyslexia to facilitate greater understanding of dyslexia and support for students with dyslexia.

Dyslexia (specific reading disability).

Converging evidence from a number of lines of investigation indicates that dyslexia represents a disorder within the language system and more specifically within a particular subcomponent of that system, phonological processing. Recent advances in imaging technology, particularly the development of functional magnetic resonance imaging, provide evidence of a neurobiological signature for dyslexia, specifically a disruption of two left hemisphere posterior brain systems, one parieto-temporal, the other occipito-temporal, with compensatory engagement of anterior systems around the inferior frontal gyrus and a posterior (right occipito-temporal) system. Furthermore, good evidence indicates a computational role for the left occipito-temporal system: the development of fluent (automatic) reading. The brain systems for reading are malleable and their disruption in dyslexic children may be remediated by provision of an evidence-based, effective reading intervention. In addition, functional magnetic resonance imaging studies of young adults with reading difficulties followed prospectively and longitudinally from age 5 through their mid twenties suggests that there may be two types of reading difficulties, one primarily on a genetic basis, the other, and far more common, reflecting environmental influences. These studies offer the promise for more precise identification and effective management of dyslexia in children, adolescents and adults.

A quantitative analysis of prenatal methyl mercury exposure and cognitive development.

Although a rich source of n-3 polyunsaturated fatty acids (PUFAs) that may confer multiple health benefits, some fish also contain methyl mercury (MeHg), which may harm the developing fetus. U.S. government recommendations for women of childbearing age are to modify consumption of high MeHg fish to reduce MeHg exposure, while recommendations encourage fish consumption among the general population because of the nutritional benefits. The Harvard Center for Risk Analysis convened an expert panel (see acknowledgements) to quantify the net impact of resulting hypothetical changes in fish consumption across the population. This paper quantifies the impact of prenatal MeHg exposure on cognitive development. Other papers quantify the beneficial impact of prenatal intake of n-3 PUFAs on cognitive function and the extent to which fish consumption protects against coronary heart disease mortality and stroke in adults. This analysis aggregates results from three major prospective epidemiology studies to quantify the association between prenatal MeHg exposure and cognitive development as measured by intelligence quotient (IQ). It finds that prenatal MeHg exposure sufficient to increase the concentration of mercury in maternal hair at parturition by 1 microg/g decreases IQ by 0.7 points. This paper identifies important sources of uncertainty influencing this estimate, concluding that the plausible range of values for this loss is 0 to 1.5 IQ points.

A quantitative analysis of prenatal intake of n-3 polyunsaturated fatty acids and cognitive development.

Although a rich source of n-3 polyunsaturated fatty acids (PUFAs) that may confer multiple health benefits, some fish also contain methyl mercury (MeHg), which may harm the developing fetus. U.S. government recommendations for women of childbearing age are to modify consumption of high-MeHg fish to reduce MeHg exposure, while recommendations encourage fish consumption among the general population because of the nutritional benefits. The Harvard Center for Risk Analysis convened an expert panel (see acknowledgements) to quantify the net impact of resulting hypothetical changes in fish consumption across the population. This paper estimates the impact of prenatal n-3 intake on cognitive development. Other papers quantify the negative impact of prenatal exposure to MeHg on cognitive development, and the extent to which fish consumption protects against coronary heart disease mortality and stroke in adults. This paper aggregates eight randomized controlled trials (RCTs) comparing cognitive development in controls and in children who had received n-3 PUFA supplementation (seven studies of formula supplementation and one study of maternal dietary supplementation). Our analysis assigns study weights accounting for statistical precision, relevance of three endpoint domains (general intelligence, verbal ability, and motor skills) to prediction of IQ, and age at evaluation. The study estimates that increasing maternal docosahexaenoic acid (DHA) intake by 100 mg/day increases child IQ by 0.13 points. The paper notes that findings were inconsistent across the RCTs evaluated (although our findings were relatively robust to changes in the weighting scheme used). Also, for seven of the eight studies reviewed, effects are extrapolated from formula supplementation to maternal dietary intake.

A quantitative risk-benefit analysis of changes in population fish consumption.

Although a rich source of n-3 polyunsaturated fatty acids (PUFAs) that may confer multiple health benefits, some fish contain methyl mercury (MeHg), which may harm the developing fetus. U.S. government recommendations for women of childbearing age are to modify consumption of high-MeHg fish, while recommendations encourage fish consumption among the general population because of nutritional benefits. To investigate the aggregate impacts of hypothetical shifts in fish consumption, the Harvard Center for Risk Analysis convened an expert panel (see acknowledgements). Effects investigated include prenatal cognitive development, coronary heart disease mortality, and stroke. Substitution of fish with high MeHg concentrations with fish containing less MeHg among women of childbearing age yields substantial developmental benefits and few negative impacts. However, if women instead decrease fish consumption, countervailing risks substantially reduce net benefits. If other adults (mistakenly and inappropriately) also reduce their fish consumption, the net public health impact is negative. Although high compliance with recommended fish consumption patterns can improve public health, unintended shifts in consumption can lead to public health losses. Risk managers should investigate and carefully consider how populations will respond to interventions, how those responses will influence nutrient intake and contaminant exposure, and how these changes will affect aggregate public health.