Investigating the Reading Profiles of Middle School Emergent Bilinguals with Significant Reading Comprehension Difficulties.

Purpose: This study investigated the reading profiles of middle school Spanish-speaking emergent bilinguals (EBs) with significantly below grade level reading comprehension and whether these profiles varied in their reading comprehension performance over time. Method: Latent profile analyses were used to classify Grade 6 and 7 Hispanic EBs (n = 340; 39% female) into subgroups based on their word reading and vocabulary knowledge. Growth models were then fit within each profile to evaluate reading comprehension performance over time. Results: Analyses revealed four latent profiles emerged: (a) very low word reading and low vocabulary (10%), (b) low word reading and low vocabulary (71%), (c) average word reading and low vocabulary (16%), and (d) high word reading and low vocabulary (3%). Subgroups varied in their reading comprehension initially and over one year. Students in the subgroup marked by very low word reading and low vocabulary showed the lowest reading comprehension performance initially; however, they also showed the greatest growth over one year. Conclusion: These findings suggest there is heterogeneity in the reading skill profiles of Spanish-speaking EBs with reading comprehension difficulties. They also underscore the prevalence of word reading difficulties among these students. These may be important factors to consider when developing interventions to prevent and remediate these difficulties.

Internalizing Symptoms and Reading Difficulties Among Early Elementary School Students.

While the field of learning disabilities has grown substantially over the past several decades (Grigorenko et al. in Am Psychol 75:37, 2020) little work has explored the role of internalizing symptoms among struggling students. The present study compared struggling and typical readers on several child reported internalizing measures at both the beginning and end of a school year during which time they received either classroom-as-usual or research-team provided intensive intervention. Struggling readers who did and did not meet reading benchmarks were also compared at year-end. While minimal differences were present at the beginning of the year, numerous differences were observed at the end, with students exhibiting persistent reading struggles reporting significantly greater distress. Bi-directional associations emerged with beginning of year group status predicting internalizing symptoms and beginning of year internalizing symptoms predicting end of year intervention response group status. Findings are discussed in terms of future directions for enhancing intervention studies of struggling readers.

The Role of Neural and Genetic Processes in Learning to Read and Specific Reading Disabilities: Implications for Instruction.

To learn to read, the brain must repurpose neural systems for oral language and visual processing to mediate written language. We begin with a description of computational models for how alphabetic written language is processed. Next, we explain the roles of a dorsal sublexical system in the brain that relates print and speech, a ventral lexical system that develops the visual expertise for rapid orthographic processing at the word level, and the role of cognitive control networks that regulate attentional processes as children read. We then use studies of children, adult illiterates learning to read, and studies of poor readers involved in intervention, to demonstrate the plasticity of these neural networks in development and in relation to instruction. We provide a brief overview of the rapid increase in the field's understanding and technology for assessing genetic influence on reading. Family studies of twins have shown that reading skills are heritable, and molecular genetic studies have identified numerous regions of the genome that may harbor candidate genes for the heritability of reading. In selected families, reading impairment has been associated with major genetic effects, despite individual gene contributions across the broader population that appear to be small. Neural and genetic studies do not prescribe how children should be taught to read, but these studies have underscored the critical role of early intervention and ongoing support. These studies also have highlighted how structured instruction that facilitates access to the sublexical components of words is a critical part of training the brain to read.

Early Detection of Dyslexia Risk: Development of Brief, Teacher-Administered Screens.

Many states now mandate early screening for dyslexia, but vary in how they address these mandates. There is confusion about the nature of screening versus diagnostic assessments, risk versus diagnosis, concurrent versus predictive validity, and inattention to indices of classification accuracy as the basis for determining risk. To help define what constitutes a screening assessment, we summarize efforts to develop short (3-5 min), teacher-administered screens that used multivariate strategies for variable selection, item response theory to select items that are most discriminating at a threshold for predicting risk, and statistical decision theory. These methods optimize prediction and lower the burden on teachers by reducing the number of items needed to evaluate risk. A specific goal of these efforts was to minimize decision errors that would result in the failure to identify a child as at risk of dyslexia/reading problems (false negatives) despite the inevitable increase in identifications of children who eventually perform in the typical range (false positives). Five screens, developed for different periods during kindergarten, Grade 1, and Grade 2, predicted outcomes measured later in the same school year (Grade 2) or in the subsequent year (Grade 1). The results of this approach to development are applicable to other screening methods, especially those that attempt to predict those children at risk of dyslexia prior to the onset of reading instruction. Without reliable and valid early predictive screening measures that reduce the burden on teachers, early intervention and prevention of dyslexia and related reading problems will be difficult.

Long-Term Intellectual and Fine Motor Outcomes in Spina Bifida Are Related to Myelomeningocele Repair and Shunt Intervention History.

OBJECTIVE: Lifespan outcomes of simultaneous versus sequential myelomeningocele repair and shunt placement or effects of repeated shunt revisions on specific domains of IQ or fine motor dexterity are largely unknown. The current study addressed these gaps in a large cohort of children and adults with spina bifida myelomeningocele (SBM). METHODS: Participants between 7 and 44 years of age with SBM and shunted hydrocephalus were recruited from international clinics at two time points. Each participant completed a standardized neuropsychological evaluation that included estimates of IQ and fine motor dexterity. Simultaneous versus sequential surgical repair and number of shunt revisions were examined in relation to long-term IQ and fine motor scores. RESULTS: Simultaneous myelomeningocele repair and shunting were associated with more frequent shunt revisions, as well as to lower Full Scale and verbal IQ scores, controlling for number of shunt revisions. More shunt revisions across study time points were associated with higher nonverbal IQ (NVIQ) scores. No effects were observed on fine motor dexterity. CONCLUSIONS: Findings indicate generally greater influence of surgery type over shunt revision history on outcomes in well-managed hydrocephalus. Findings supported apparent, domain-specific benefits of sequential compared to simultaneous surgery across the lifespan in SBM. Higher NVIQ scores with greater number of additional shunt revisions across surgery type supported positive outcomes with effective surgical management for hydrocephalus.

Role of Neurocognitive Factors in Academic Fluency for Children and Adults With Spina Bifida Myelomeningocele.

OBJECTIVES: Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. METHODS: Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses. RESULTS: Univariate regressions were significant and robust (R 2 =.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary. CONCLUSIONS: The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249-265).

Cortical Thickness and Local Gyrification in Children with Developmental Dyslexia.

Developmental dyslexia is frequently associated with atypical brain structure and function within regions of the left hemisphere reading network. To date, few studies have employed surface-based techniques to evaluate cortical thickness and local gyrification in dyslexia. Of the existing cortical thickness studies in children, many are limited by small sample size, variability in dyslexia identification, and the recruitment of prereaders who may or may not develop reading impairment. Further, no known study has assessed local gyrification index (LGI) in dyslexia, which may serve as a sensitive indicator of atypical neurodevelopment. In this study, children with dyslexia (n = 31) and typically decoding peers (n = 45) underwent structural magnetic resonance imaging to assess whole-brain vertex-wise cortical thickness and LGI. Children with dyslexia demonstrated reduced cortical thickness compared with controls within previously identified reading areas including bilateral occipitotemporal and occipitoparietal regions. Compared with controls, children with dyslexia also showed increased gyrification in left occipitotemporal and right superior frontal cortices. The convergence of thinner and more gyrified cortex within the left occipitotemporal region among children with dyslexia may reflect its early temporal role in processing word forms, and highlights the importance of the ventral stream for successful word reading.

Control Engagement During Sentence and Inhibition fMRI Tasks in Children With Reading Difficulties.

Recent reading research implicates executive control regions as sites of difference in struggling readers. However, as studies often employ only reading or language tasks, the extent of deviation in control engagement in children with reading difficulties is not known. The current study investigated activation in reading and executive control brain regions during both a sentence comprehension task and a nonlexical inhibitory control task in third-fifth grade children with and without reading difficulties. We employed both categorical (group-based) and individual difference approaches to relate reading ability to brain activity. During sentence comprehension, struggling readers had less activation in the left posterior temporal cortex, previously implicated in language, semantic, and reading research. Greater negative activity (relative to fixation) during sentence comprehension in a left inferior parietal region from the executive control literature correlated with poorer reading ability. Greater comprehension scores were associated with less dorsal anterior cingulate activity during the sentence comprehension task. Unlike the sentence task, there were no significant differences between struggling and nonstruggling readers for the nonlexical inhibitory control task. Thus, differences in executive control engagement were largely specific to reading, rather than a general control deficit across tasks in children with reading difficulties, informing future intervention research.

How Initial Word Reading and Language Skills Affect Reading Comprehension Outcomes for Students With Reading Difficulties.

This study examined how differences in listening comprehension and word reading at the beginning of the school year influence changes in reading comprehension for English learners (ELs) with significant reading difficulties compared to non-ELs with significant reading difficulties. The study investigated heterogeneity in response to instruction among 400 struggling readers in fourth grade (n = 183 for non-EL; n = 217 for EL) who received an intensive reading intervention. At pretest, word reading, listening comprehension, and reading comprehension were measured, and at posttest, reading comprehension was measured again. Results from moderated multiple regression analyses showed a significant three-way interaction such that reading comprehension at posttest was higher for ELs than non-ELs with similar levels of low word reading but relatively higher levels of listening comprehension. However, non-ELs outperformed ELs with similar levels of relatively high word reading and average to high listening comprehension. The findings suggest that pre-intervention skill profiles may need to be interpreted differently for ELs and non-ELs with significant reading difficulties in relation to language and literacy outcomes.

Cognitive, Intervention, and Neuroimaging Perspectives on Executive Function in Children With Reading Disabilities.

The role of executive function (EF) in the reading process, and in those with reading difficulties, remains unclear. As members of the Texas Center for Learning Disabilities, we review multiple perspectives regarding EF in reading and then summarize some of our recent studies of struggling and typical readers in grades 3-5. Study 1a found that a bi-factor structure best represented a comprehensive assessment of EF. Study 1b found that cognitive and behavioral measures of EF related independently to math and reading. Study 1c found that EF related to reading, above and beyond other variables, but Study 1d found no evidence that adding an EF training component improved intervention response. Study 1e found that pretest EF abilities did not relate to intervention response. Neuroimaging studies examined EF-related brain activity during both reading and nonlexical EF tasks. In Study 2a, the EF task evoked control activity, but generated no differences between struggling and typical readers. The reading task, however, had group differences in both EF and reading regions. In Study 2b, EF activity during reading at pretest was related to intervention response. Across studies, EF appears involved in the reading process. There is less evidence for general EF predicting or improving intervention outcomes.

Simulation of LD Identification Accuracy Using a Pattern of Processing Strengths and Weaknesses Method With Multiple Measures.

We investigated the classification accuracy of learning disability (LD) identification methods premised on the identification of an intraindividual pattern of processing strengths and weaknesses (PSW) method using multiple indicators for all latent constructs. Known LD status was derived from latent scores; values at the observed level identified LD status for individual cases according to the concordance/discordance method. Agreement with latent status was evaluated using (a) a single indicator, (b) two indicators as part of a test-retest "confirmation" model, and (c) a mean score. Specificity and negative predictive value (NPV) were generally high for single indicators (median specificity = 98.8%, range = 93.4%-99.7%; median NPV = 94.2%, range = 85.6%-98.7%), but low for sensitivity (median sensitivity = 49.1%, range = 20.3%-77.1%) and positive predictive value (PPV; median PPV = 48.8%, range = 23.5%-69.6%). A test-retest procedure produced inconsistent and small improvements in classification accuracy, primarily in "not LD" decisions. Use of a mean score produced small improvements in classifications (mean improvement = 2.0%, range = 0.3%-2.8%). The modest gains in agreement do not justify the additional testing burdens associated with incorporating multiple tests of all constructs.

Neuropsychology of Learning Disabilities: The Past and the Future.

Over the past 50 years, research on children and adults with learning disabilities has seen significant advances. Neuropsychological research historically focused on the administration of tests sensitive to brain dysfunction to identify putative neural mechanisms underlying learning disabilities that would serve as the basis for treatment. Led by research on classifying and identifying learning disabilities, four pivotal changes in research paradigms have produced a contemporary scientific, interdisciplinary, and international understanding of these disabilities. These changes are (1) the emergence of cognitive science, (2) the development of quantitative and molecular genetics, (3) the advent of noninvasive structural and functional neuroimaging, and (4) experimental trials of interventions focused on improving academic skills and addressing comorbid conditions. Implications for practice indicate a need to move neuropsychological assessment away from a primary focus on systematic, comprehensive assessment of cognitive skills toward more targeted performance-based assessments of academic achievement, comorbid conditions, and intervention response that lead directly to evidence-based treatment plans. Future research will continue to cross disciplinary boundaries to address questions regarding the interaction of neurobiological and contextual variables, the importance of individual differences in treatment response, and an expanded research base on (a) the most severe cases, (b) older people with LDs, and (c) domains of math problem solving, reading comprehension, and written expression. (JINS, 2017, 23, 930-940).

Are Shunt Revisions Associated with IQ in Congenital Hydrocephalus? A Meta -Analysis.

Although it is generally acknowledged that shunt revisions are associated with reductions in cognitive functions in individuals with congenital hydrocephalus, the literature yields mixed results and is inconclusive. The current study used meta-analytic methods to empirically synthesize studies addressing the association of shunt revisions and IQ in individuals with congenital hydrocephalus. Six studies and three in-house datasets yielded 11 independent samples for meta-analysis. Groups representing lower and higher numbers of shunt revisions were coded to generate effect sizes for differences in IQ scores. Mean effect size across studies was statistically significant, but small (Hedges' g = 0.25, p < 0.001, 95 % CI [0.08, 0.43]) with more shunt revisions associated with lower IQ scores. Results show an association of lower IQ and more shunt revisions of about 3 IQ points, a small effect, but within the error of measurement associated with IQ tests. Although clinical significance of this effect is not clear, results suggest that repeated shunt revisions because of shunt failure is associated with a reduction in cognitive functions.

Do Processing Patterns of Strengths and Weaknesses Predict Differential Treatment Response?

OBJECTIVE: No previous empirical study has investigated whether the LD identification decisions of proposed methods to operationalize processing strengths and weaknesses (PSW) approaches for LD identification are associated with differential treatment response. We investigated whether the identification decisions of the concordance/discordance model (C/DM; Hale & Fiorello, 2004) and Cross Battery Assessment approach (XBA method; Flanagan, Ortiz, & Alfonso, 2007) were consistent and whether they predicted intervention response beyond that accounted for by pretest performance on measures of reading. METHOD: Psychoeducational assessments were administered at pretest to 203 4th graders with low reading comprehension and individual results were utilized to identify students who met LD criteria according to the C/DM and XBA methods and students who did not. Resulting group status permitted an investigation of agreement for identification methods and whether group status at pretest (LD or not LD) was associated with differential treatment response to an intensive reading intervention. RESULTS: The LD identification decisions of the XBA and C/DM demonstrated poor agreement with one another (κ = -.10). Comparisons of posttest performance for students who met LD criteria and those who did not meet were largely null, with small effect sizes across all measures. CONCLUSIONS: LD status, as identified through the C/DM and XBA approaches, was not associated with differential treatment response and did not contribute educationally meaningful information about how students would respond to intensive reading intervention. These results do not support the value of cognitive assessment utilized in this way as part of the LD identification process.

The Impact of Intensive Reading Intervention on Level of Attention in Middle School Students.

The purpose of the study was to estimate the impact of reading intervention on ratings of student attention over time. We used extant data from a longitudinal randomized study of a response-based reading intervention to fit a multiple-indicator, multilevel growth model. The sample at randomization was 54% male, 18% limited English proficient, 85% eligible for free or reduced-price lunch, 58% African American, and 32% Hispanic. Reading ability was measured by using the Woodcock-Johnson III Tests of Achievement. Attention was measured by using the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale. Findings indicate that intensive, response-based reading intervention over 3 years improved reading achievement and behavioral attention in middle school struggling readers, with treatment directly affecting reading, which in turn influenced attention. In the business-as-usual condition, there was no relation between improved reading and attention. The results are consistent with a correlated liabilities model of comorbidity. The results do not align with the inattention-as-cause hypothesis, which predicts that reading intervention should not affect attention. The findings do not support, but do not necessarily preclude, the phenocopy hypothesis. The results are especially pertinent for older students who may be inattentive partly because of years of struggling with reading.

Are Child Cognitive Characteristics Strong Predictors of Responses to Intervention? A Meta-Analysis.

We conducted a meta-analysis of 28 studies comprising 39 samples to ask the question, "What is the magnitude of the association between various baseline child cognitive characteristics and response to reading intervention?" Studies were located via literature searches, contact with researchers in the field, and review of references from the National Reading Panel Report. Eligible participant populations included at-risk elementary school children enrolled in the third grade or below. Effects were analyzed using a shifting unit of analysis approach within three statistical models: cognitive characteristics predicting growth curve slope (Model 1, mean r = .31), gain (Model 2, mean r = .21), or postintervention reading controlling for preintervention reading (Model 3, mean r = .15). Effects were homogeneous within each model when effects were aggregated within study. The small size of the effects calls into question the practical significance and utility of using cognitive characteristics for prediction of response when baseline reading is available.

Functional plasticity in childhood brain disorders: when, what, how, and whom to assess.

At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.

Covert orienting in three etiologies of congenital hydrocephalus: the effect of midbrain and posterior fossa dysmorphology.

Covert orienting is related to the integrity of the midbrain, but the specificity of the relation is unclear. We compared covert orienting in three etiologies of congenital hydrocephalus (aqueductal stenosis [AS], Dandy-Walker malformation [DWM], and spina bifida myelomeningocele [SBM]--with and without tectal beaking) to explore the effects of midbrain and posterior fossa malformations. We hypothesized a stepwise order of group performance reflecting the degree of midbrain tectum dysmorphology. Performance on an exogenously cued covert orienting task was compared using repeated measures analysis of covariance, controlling for age. Individuals with SBM and tectal beaking demonstrated the greatest disengagement cost in the vertical plane, whereas individuals with AS performed as well as a typically developing (TD) group. Individuals with SBM but no tectal beaking and individuals with DWM showed greater disengagement costs in the vertical plane relative to the TD group, but better performance relative to the group with SBM and tectal beaking. Individuals with AS, DWM, and SBM and tectal beaking demonstrated poorer inhibition of return than TD individuals. Impairments in attentional disengagement in SBM are not attributable to the general effects of hydrocephalus, but are instead associated with specific midbrain anomalies that are part of the Chiari II malformation.

Alternative approaches to outcomes assessment: beyond psychometric tests.

Outcomes assessments in clinical trials involving cognition and behavior rely upon IQ and neuropsychological assessments. These procedures provide limited evaluations of everyday functions. Some participants cannot perform cognitive tasks because they are low functioning or may represent missing data because of inability to travel. Interview-based assessments of adaptive behavior yield results that reflect everyday functions and can be done by telephone regardless of level of cognitive functioning. The design of the neurobehavioral component of the follow-up study for the management of myelomeningocele fetal surgery trial is as an example of a clinical trial that incorporates these alternatives.