Effects of a developmental dyslexia remediation protocol based on the training of audio-phonological cognitive processes in dyslexic children with high intellectual potential: study protocol for a multiple-baseline single-case experimental design.

BACKGROUND: The significant prevalence of children with high intellectual potential (HIP) in the school-age population and the high rate of comorbidity with learning disabilities such as dyslexia has increased the demand for speech and language therapy and made it more complex. However, the management of dyslexic patients with high intellectual potential (HIP-DD) is poorly referenced in the literature. A large majority of studies on HIP-DD children focus on the screening and diagnosis of developmental dyslexia, but only a few address remediation. Developmental dyslexia is a severe and persistent disorder that affects the acquisition of reading and implies the impairment of several underlying cognitive processes. These include deficits in Categorical Perception, Rapid Automatized Naming, and phonological awareness, particularly phonemic awareness. Some authors claim that HIP-DD children's underlying deficits mainly concern rapid automatized naming and phonological awareness. Thus, the purpose of this study is to present a remediation protocol for developmental dyslexia in HIP-DD children. This protocol proposes to compare the effects on reading skills of an intensive intervention targeting categorical perception, rapid automatized naming, and phonemic analysis versus standard speech therapy remediation in HIP-DD children. METHODS: A multiple-baseline single-case experimental design (A1BCA2) will be proposed to 4 French HIP-DD patients for a period of 30 weeks. Intervention phases B and C correspond to categorical perception training and rapid automatized naming training. During phases B and C, each training session will be associated with phonemic analysis training and a reading and writing task. At inclusion, a speech and language, psychological, and neuropsychological assessment will be performed to define the four patients' profiles. Patients will be assigned to the different baseline lengths using a simple computerized randomization procedure. The duration of the phases will be counterbalanced. The study will be double blinded. A weekly measurement of phonological and reading skills will be performed for the full duration of the study. DISCUSSION: The purpose of this protocol is to observe the evolution of reading skills with each type of intervention. From this observation, hypotheses concerning the remediation of developmental dyslexia in HIP-DD children can be tested. The strengths and limitations of the study are discussed. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04028310 . Registered on July 18, 2019. Version identifier is no. ID RCB 2019-A01453-54, 19-HPNCL-02, 07/18/2019.

Multimodal intervention in 8- to 13-year-old French dyslexic readers: Study protocol for a randomized multicenter controlled crossover trial.

BACKGROUND: Developmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual's cognitive profile as part of a longitudinal intervention study. METHODS: This multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an "intention-to-treat" analysis will be performed on the children who quit the trial before the end. DISCUSSION: The main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04028310. Registered on July 18, 2019.

Are French dyslexic children sensitive to consonant sonority in segmentation strategies? Preliminary evidence from a letter detection task.

This paper aims to investigate whether--and how--consonant sonority (obstruent vs. sonorant) and status (coda vs. onset) within syllable boundaries modulate the syllable-based segmentation strategies. Here, it is questioned whether French dyslexic children, who experience acoustic-phonetic (i.e., voicing) and phonological impairments, are sensitive to an optimal 'sonorant coda-obstruent onset' sonority profile as a cue for a syllable-based segmentation. To examine these questions, we used a modified version of the illusory conjunction paradigm with French dyslexic children compared with both chronological age-matched and reading level-matched controls. Our results first showed that the syllable-based segmentation is developmentally constrained in visual identification: in normally reading children, it appears to progressively increase as reading skills increase. However, surprisingly, our results also showed that dyslexic children were able to use syllable-sized units. Then, data highlighted that a syllable-based segmentation in visual identification basically relies on an optimal 'sonorant coda-obstruent onset' sonority profile rather than on phonological and orthographic statistical properties in normally reading children as well as, surprisingly, in dyslexic children. Our results are discussed to support a sonority-modulated prelexical role of syllable-sized units in visual identification in French, even in dyslexic children who exhibited a developmentally delayed profile. We argue that dyslexic children have deficits in online phonetic-phonological processing rather than degraded or underspecified phonetic-phonological representations.

Are syllabification and resyllabification strategies phonotactically directed in French children with dyslexia? A preliminary report.

PURPOSE: In this study, the authors queried whether French-speaking children with dyslexia were sensitive to consonant sonority and position within syllable boundaries to influence a phonological syllable-based segmentation in silent reading. METHOD: Participants included 15 French-speaking children with dyslexia, compared with 30 chronological age-matched and reading level-matched controls. Children were tested with an audiovisual recognition task. A target pseudoword (TOLPUDE) was simultaneously presented visually and auditorily and then was compared with a printed test pseudoword that either was identical or differed after the coda deletion (TOPUDE) or the onset deletion (TOLUDE). The intervocalic consonant sequences had either a sonorant coda-sonorant onset (TOR.LADE), sonorant coda-obstruent onset (TOL.PUDE), obstruent coda-sonorant onset (DOT.LIRE), or obstruent coda-obstruent onset (BIC.TADE) sonority profile. RESULTS: All children processed identity better than they processed deletion, especially with the optimal sonorant coda-obstruent onset sonority profile. However, children preserved syllabification (coda deletion; TO.PUDE) rather than resyllabification (onset deletion; TO.LUDE) with intervocalic consonant sequence reductions, especially when sonorant codas were deleted but the optimal intersyllable contact was respected. CONCLUSIONS: It was surprising to find that although children with dyslexia generally exhibit phonological and acoustic-phonetic impairments (voicing), they showed sensitivity to the optimal sonority profile and a preference for preserved syllabification. The authors proposed a sonority-modulated explanation to account for phonological syllable-based processing. Educational implications are discussed.

Automatic activation of phonology in silent reading is parallel: evidence from beginning and skilled readers.

The picture-word interference paradigm was used to shed new light on the debate concerning slow serial versus fast parallel activation of phonology in silent reading. Prereaders, beginning readers (Grades 1-4), and adults named pictures that had words printed on them. Words and pictures shared phonology either at the beginnings of words (e.g., DOLL-DOG) or at the ends of words (e.g., FOG-DOG). The results showed that phonological overlap between primes and targets facilitated picture naming. This facilitatory effect was present even in beginning readers. More important, from Grade 1 onward, end-related facilitation always was as strong as beginning-related facilitation. This result suggests that, from the beginning of reading, the implicit and automatic activation of phonological codes during silent reading is not serial but rather parallel.

Phonological neighbourhood density: effects in a rhyme awareness task in five-year-old children.

Phonological awareness skills are critical for reading acquisition, yet relatively little is known about the origins of phonological awareness. This study investigates one plausible source of the emergence of phonological awareness, phonological neighbourhood density. As vocabulary grows, the number of similar-sounding words in the child's mental lexicon increases. This could create developmental pressure to develop awareness of sub-units within words such as syllables, rhymes and phonemes. If this is the case, then neighbourhood density effects should be discernible in phonological awareness tasks. Children should be more successful in these tasks with words from dense phonological neighbourhoods, as they should show greater awareness of sub-units within these words. We investigated this hypothesis in a group of 48 five-year-old children, most of whom were pre-readers. The five-year-olds with a high vocabulary age showed neighbourhood density effects in a rhyme oddity task, but five-year-olds with lower vocabulary ages did not. This suggests that vocabulary acquisition and consequent neighbourhood density effects are indeed one source of the emergence of phonological awareness skills in pre-readers.

Similarity relations among spoken words: the special status of rimes in English.

This paper presents an analysis of the distribution of phonological similarity relations among monosyllabic spoken words in English. It differs from classical analyses of phonological neighborhood density (e.g., Luce & Pisoni, 1998) by assuming that not all phonological neighbors are equal. Rather, it is assumed that the phonological lexicon has psycholinguistic structure. Accordingly, in addition to considering the number of phonological neighbors for any given word, it becomes important to consider the nature of these neighbors. If one type of neighbor is more dominant, neighborhood density effects may reflect levels of segmental representation other than the phoneme, particularly prior to literacy. Statistical analyses of the nature of phonological neighborhoods in terms of rime neighbors (e.g., hat/cat), consonant neighbors (e.g., hat/hit), and lead neighbors (e.g., hat/ham) were thus performed for all monosyllabic words in the Celex corpus (4,086 words). Our results show that most phonological neighbors are rime neighbors (e.g., hat/cat) in English. Similar patterns were found when a corpus of words for which age-of-acquisition ratings were available was analyzed. The resultant database can be used as a tool for controlling and selecting stimuli when the role of lexical neighborhoods in phonological development and speech processing is examined.