Action video games and posterior parietal cortex neuromodulation enhance both attention and reading in adults with developmental dyslexia.

The impact of action video games on reading performance has been already demonstrated in individuals with and without neurodevelopmental disorders. The combination of action video games and posterior parietal cortex neuromodulation by a transcranial random noise stimulation could enhance brain plasticity, improving attentional control and reading skills also in adults with developmental dyslexia. In a double blind randomized controlled trial, 20 young adult nonaction video game players with developmental dyslexia were trained for 15 h with action video games. Half of the participants were stimulated with bilateral transcranial random noise stimulation on the posterior parietal cortex during the action video game training, whereas the others were in the placebo (i.e. sham) condition. Word text reading, pseudowords decoding, and temporal attention (attentional blink), as well as electroencephalographic activity during the attentional blink, were measured before and after the training. The action video game + transcranial random noise stimulation group showed temporal attention, word text reading, and pseudoword decoding enhancements and P300 amplitude brain potential changes. The enhancement in temporal attention performance was related with the efficiency in pseudoword decoding improvement. Our results demonstrate that the combination of action video game training with parietal neuromodulation increases the efficiency of visual attention deployment, probably reshaping goal-directed and stimulus-driven fronto-parietal attentional networks interplay in young adults with neurodevelopmental conditions.

Computerized Executive Functions Training: The efficacy on reading performance of children with dyslexia.

This study aimed to test the efficacy of a newly developed computer-based game naming computerized executive functions (CEF) task on the reading ability of children suffering from dyslexia. Forty dyslexic school students from the fourth and fifth grades were randomized to one of the experimental and control groups. Subjects of the experimental group received 12 sessions of Computerized Executive Functions Training (CEFT), while subjects of the control group played a neutral computer game throughout the 12 sessions. All participants responded to the Reading and Dyslexia Test (NEMA) as the pre- and post-test measure. Results revealed a significant improvement in the reading ability of subjects of the experimental group compared to the control group. Subjects of the experimental group indicated a greater improvement in some components of the NEMA scale including word reading, word chains reading, picture naming, text comprehension, word comprehension and letter fluency relative to the control group. CEFT had no significant effect in modifying the category fluency, phoneme elimination and rhyming components of the NEMA scale. Applying CEFT improves the reading performance of children with dyslexia by enforcing their cognitive abilities like working memory, inhibition control and cognitive flexibility which are necessary for normal reading ability.

The challenge of remote treatment in neuropsychological intervention for reading and spelling in dyslexia: A prospective observational cohort study.

Telemedicine approaches have proved to be valuable solutions for the delivery of treatment for many health-related issues, and crucial during the pandemics. Nonetheless, the efficacy of such Web-based practices in developmental dyslexia needs to be thoroughly evaluated. To this aim, the effects of a multi-componential program for neuropsychological intervention in dyslexia delivered as an outpatient program were compared with those obtained with a remotely delivered, Web-based treatment, based on the same methodological principles and delivered with the same duration and intensity. The treatment-related changes obtained with a combination of visual hemisphere-specific stimulation and training of visual-spatial attention through action video games, were compared to those obtained through remote treatment via the Tachidino Web-based platform. Both treatments had a duration of 4 weeks. The same battery of reading and phonemic awareness tests was delivered in presence, before and after treatment, as well as at 6-months follow-up. User satisfaction was assessed through parents and user questionnaires. Both treatments were significantly and similarly effective in improving reading speed, reading accuracy, and writing accuracy. No reduction in the effects was observed after treatment discontinuation. The Web-based treatment may thus offer a valid alternative to in-person intervention, optimizing the flexibility, capillary diffusion and cost-effectiveness of intervention.

Combined multi-session transcranial alternating current stimulation (tACS) and language skills training improves individual gamma band activity and literacy skills in developmental dyslexia.

Developmental dyslexia is characterized by the pathologically diminished ability to acquire reading and spelling skills. Accurate processing of acoustic information at the phonemic scale is crucial for successful sound-to-letter-mapping which, in turn, is elemental in reading and spelling. Altered activation patterns in the auditory cortex are thought to provide the neurophysiological basis for the inaccurate phonemic perception. Recently, transcranial electrical stimulation has been shown to be an effective method to ameliorate cortical activation patterns in the auditory cortex. In a sample of children and adolescents with dyslexia, we investigated the effect of multi-session transcranial alternating current stimulation delivered concurrently with a phonological training and in combination with a behavioral literacy skills training. Over a 5-week period the participants received 10 training sessions while gamma-tACS was administered over bilateral auditory cortex. We found that gamma-tACS shifted the peak frequency of auditory gamma oscillations reflecting a more fine-grained processing of time-critical acoustic information. This amelioration was accompanied by increased phonemic processing skills. Moreover, individuals who received gamma-tACS showed significant improvements in their spelling skills four months after the intervention. Our results demonstrate that multi-session gamma-tACS enhances the effects of a behavioral intervention and induces long-term improvement on literacy skills in dyslexia.

Conceptions and Misconceptions: What Do School-Based Speech-Language Pathologists Think About Dyslexia?

PURPOSE: The purpose of this exploratory study was to evaluate speech-language pathologists' (SLPs') conceptions and misconceptions about dyslexia. METHOD: Participants were 86 school-based SLPs. They completed an online survey on which they rated their agreement and disagreement with true and false statements related to the scientific evidence about the nature of dyslexia and interventions for dyslexia, as well as common misconceptions about dyslexia. RESULTS: There was considerable variability among SLPs' agreement and disagreement with the statements. Critically, despite abundant contrary evidence in the literature, many SLPs believe that dyslexia involves a visual processing deficit. CONCLUSIONS: These findings suggest that many school-based SLPs hold misconceptions about dyslexia, especially those related to dyslexia being a visual disorder. The identified misconceptions may contribute to some SLPs' reluctance to incorporate reading and prereading skills into speech-language assessment and intervention. SLPs need greater knowledge of dyslexia to provide more effective evaluations and intervention services.

Effects of a phonics intervention in a randomized controlled study in Swedish second-grade students at risk of reading difficulties.

Teaching phoneme awareness to children at risk for early reading difficulties has been recognized as successful in several studies. In this randomized controlled trial (RCT)-study, we add to this research by optimizing core procedural as well as teaching components in a phonics-directed intervention and extend the RCT reading intervention research into a semi-transparent language context. The aim of the present study was to evaluate the effects of a novel Swedish intensive phonics program. This randomized controlled pre-test and post-test intervention study targeted second-grade students with early reading difficulties. Students were identified by a repeated screening procedure and allocated to intervention (n = 34) and control (n = 34) conditions. A 9-week intensive phonics-based program was administrated one-to-one, by special education teachers in Swedish mainstream elementary schools. Results show an improvement in the intervention group, compared with the controls on all outcome measures. Findings indicate that the supplementary phonics program, delivered with high intensity, can significantly increase word reading skills and reading comprehension in second-grade students with early reading difficulties.

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.

On Support for Dyslexic Students in Senior-High School and Higher Education.

It is very difficult to provide dyslexic students in senior-high school or higher education with all necessary textbooks in ordinary accessible format such as multimedia DAISY. Here, a new approach to provide them with a new type of accessible textbooks named "Fixed-Layout DAISY" is shown. In it, the whole page is treated as a multi-layer picture, the front layer of which has the same form as the original PDF. A DAISY (EPUB3) player can read out any texts together with highlighting them. It does not have the reflow function. The page layout is always kept as same as the original. It does not have information either in which order texts on the page should be read out, and readers need to click a text block on a page where they want to read. Dyslexic people can see and click a place where they want to read, and obviously, Fixed-Layout DAISY should work for them. Fixed-Layout DAISY can be produced almost automatically from an original "e-born PDF" by making use of our OCR system, and it should be very helpful for the dyslexic students to get accessible version of their textbooks.

Intervention targeting different visual attention span components in Chinese children with developmental dyslexia: a study based on Bundesen's theory of visual attention.

Within the framework of the theory of visual attention (TVA), the visual attention span (VAS) deficit among individuals with developmental dyslexia has been ascribed to the problems entailed by bottom-up (BotU) and top-down (TopD) attentional processes. The former involves two VAS subcomponents: the visual short-term memory storage and perceptual processing speed; the latter consists of the spatial bias of attentional weight and the inhibitory control. Then, what about the influences of the BotU and TopD components on reading? Are there differences in the roles of the two types of attentional processes in reading? This study addresses these issues by using two types of training tasks separately, corresponding to the BotU and TopD attentional components. Three groups of Chinese children with dyslexia-15 children each in the BotU training, TopD training, and non-trained active control groups were recruited here. Participants completed reading measures and a CombiTVA task which was used to estimate VAS subcomponents, before and after the training procedure. Results showed that BotU training improved both the within-category and between-category VAS subcomponents and sentence reading performance; meanwhile, TopD training enhanced character reading fluency through improving spatial attention capacity. Moreover, benefits on attentional capacities and reading skills in the two training groups were generally maintained three months after the intervention. The present findings revealed diverse patterns in the influences of VAS on reading within the TVA framework, which contributes to enriching the understanding of VAS-reading relation.

Rethinking Literacy Intervention: Addressing a Practice Gap With Best Practices From Multisensory Structured Language Approaches.

PURPOSE: Dyslexia is increasingly being defined, assessed, diagnosed, and treated in the educational system. The purpose of this clinical focus article is to elucidate ways in which speech-language pathologists (SLPs) can rethink how to implement literacy interventions to incorporate best practices from multisensory structured language (MSL) approaches and how they can be influential participants in the conversations of how to define and implement services for students who have written language disorders, including dyslexia, in the school setting. METHOD: This clinical focus article provides an operational definition of dyslexia, discusses the various roles and responsibilities of SLPs with respect to dyslexia, and describes the well-established evidence-based practices of MSL approaches as a means of rethinking literacy intervention. RESULTS: Using a case study scenario based on an individual diagnosed with dyslexia, this clinical focus article presents similarities and differences between traditional speech-language pathology intervention approaches and MSL approaches to literacy intervention. CONCLUSIONS: MSL strategies may be considered in literacy intervention as a means to optimize the academic gains of children with dyslexia in a school setting. Furthermore, SLPs should be considered integral participants in discussions of policies and practices related to the diagnosis and treatment of literacy disorders, including dyslexia. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23228483.

Word reading transfer in two distinct languages in reading interventions: How Chinese-English bilingual children with reading difficulties learn to read.

PURPOSE: Skills developed from literacy training in L1 are shown to transfer to reading in L2 when both languages involve an alphabetic writing system. However, transfer of literacy skills between a logographic L1 and an alphabetic L2 is less studied. This study examined whether the gain in literacy skills after an 8-week training on 1) Chinese character recognition or 2) English phonics, may generalize across the two languages in Chinese elementary students with reading disabilities. METHODS: Chinese-speaking students identified with reading difficulties were randomly assigned to the Chinese intervention (Chinese character orthography training), English intervention (English phonics training), and control groups. Their Chinese and English literacy skills were measured before and after the interventions. RESULTS: Though training on the orthography of Chinese characters significantly improved performance in Chinese word reading and Chinese orthographic awareness, our results did not provide evidence for the generalization of word-decoding skills from L1 Chinese to word reading in L2 English. However, phonics training in L2 English benefitted not only English word reading, but also cross-language word reading in L1 Chinese. CONCLUSION: We postulated that teaching children analytical skills in decoding words in an alphabetic writing system might likewise benefit their word decoding in a logographic script.

Speech therapy to overcome dyslexia in primary schoolers.

This research was aimed to investigate changes in the reading technique and in terms of its semantic charge in primary schoolers diagnosed with dyslexia, which occur as a result of the integrated use of speech therapy techniques. The study was performed between 2016 and 2019 in 6 schools of Moscow and Almaty. It enrolled 194 and 200 children, respectively, who were examined with form I to III inclusive. The study revealed that 13% of children had reading speed disorders; they were constituted group 1. Another 11% had reading comprehension disorders; they constituted group 2. In group 1, by form III, the number of reading repetitions increased twofold. In group 2, the number of children, who read in words and phrases, increased by half; in group 1, it doubled. This research showed clear progress in children with technical dyslexia vs. those with semantic dyslexia. Based on the results, it is possible to develop a methodology for speech therapy techniques that can be suitable not only for speech therapists, but also for primary school teachers, as well as for parents of dyslectic children.

Speech therapy and hyperbaric oxygen for aphasia after carbon monoxide intoxication.

Acute carbon monoxide (CO) intoxication may result in delayed neurological sequelae, which can include amnesia, ataxia, aphasia, emotional lability, disorientation, dysphagia, and other manifestations. A 27-year-old man reported symptoms of aphasia with agraphia and alexia in a review after CO intoxication. The patient received outpatient speech therapy, as well as repeated sessions of hyperbaric oxygen for 15 days, interspersing speech therapy with hyperbaric oxygen therapy for two months. After this period of combined treatment the aphasic symptomatology remitted, and oral and written language was normal. The complete disappearance of aphasia with agraphia and alexia confirms the efficacy of the combined intervention. More data from large clinical studies are needed to assess the outcomes of hyperbaric oxygen treatment in patients with delayed neurological sequelae after CO intoxication, but this case suggests it may be a good therapeutic option in combination with specific speech therapy.

Short report on a syllable-based intervention to improve phonemic awareness and reading in children with DLD.

With fragile phonological representations, children with developmental language disorder (DLD) risk failure when learning to read. The study reported that teaching letters-to-syllable relationships can improve phonemic awareness skills or reading performances of three French-speaking children with DLD, using a single case methodology with an AB design. These findings are promising for children at risk of reading disability and extend current knowledge concerning syllable-based teaching for developing literacy.

Examining fidelity reporting within studies of foundational reading interventions for elementary students with or at risk for dyslexia.

Early access to evidence-based reading intervention improves outcomes for students with or at risk for reading difficulties. Additionally, teacher implementation of reading interventions plays a key role in the efficacy of reading interventions. Previous research suggests the influence of intervention implementation fidelity on student language and literacy outcomes is more significant for lower-performing students and students with disabilities, such as dyslexia. However, recent syntheses have suggested that less than half of reading intervention studies report treatment fidelity data. This meta-analysis examined fidelity reporting within reading intervention studies for students with or at risk for dyslexia in Grades K-5. We aimed to record the frequency and extent of fidelity reporting, explore associations between study or intervention features and fidelity reporting, and compare mean intervention effect sizes for studies reporting fidelity and those that did not. A total of 51 studies were included. Results indicated that 75% of studies reported fidelity data. Studies reporting fidelity primarily focused on adherence and dosage data with little to no information reported for other dimensions of fidelity (i.e., quality, responsiveness, differentiation). Suggestions for improving reporting of treatment fidelity data are discussed.

Small-Group, Emergent Literacy Intervention Under Two Implementation Models: Intent-to-Treat and Dosage Effects for Preschoolers at Risk for Reading Difficulties.

Preschool-age children identified as at risk for later reading difficulties can benefit from supplemental, small-group emergent literacy intervention. As such interventions become commercially available and marketed to preschool programs, it is important to understand their impacts when implemented by intended end users under routine conditions. In this study, we examined the effects of the Nemours BrightStart! (NBS!) intervention on children's emergent literacy skills when implemented by teachers and community aides in authentic preschool classrooms. We randomly assigned 98 classrooms to one of three conditions (NBS! teacher-implemented, NBS! community aide-implemented, or control). Children enrolled in these classrooms who met eligibility criteria and were identified as at risk via an early literacy screener (n = 281) completed pretest and posttest emergent literacy assessments; those assigned to NBS! conditions received intervention from their classroom teacher or a community aide affiliated with a local kindergarten-readiness initiative. Intent-to-treat analyses showed no significant impacts of NBS! on any outcome, and an instrumental variable, as-treated approach showed one significant intervention effect on letter writing. Consequently, we did not replicate results of prior highly controlled efficacy trials. Findings have implications for revising the NBS! theory of change, conducting dosage and as-treated analyses, and moving research-based interventions toward scale-up.

Parent-implemented intervention for children in third to fifth grade with dyslexia.

BACKGROUND: Few studies have investigated the acceptability and efficacy of intensive parent-implemented interventions for children with dyslexia. METHODS: We carried out a randomized controlled trial on 22 dyslexic children from 3rd to 5th grade. Reading performance was measured before (T1) and after (T2) summer by a selection of tests from the BALE and EDA batteries. One group received a specific parent-implemented repeated reading training (RR group) and the other group received a general training based on a summer vacation workbook (SVW group), adapted for children with reading impairment. The training lasted 6 weeks during the summer vacation. RESULTS: In both groups, the reading performances of the dyslexic children were stable before and after the summer. No group difference was found on our primary outcome corresponding to an aggregate score of the z-scores of the BALE reading lists of regular, irregular and pseudo-words. However, secondary analyses revealed that the score of the EDA subtest "number of words read in one minute" (tapping reading fluency) differed significantly between the two groups (T2-T1=0.17 SD for the RR group and T2-T1=-0.24 SD for the SVW group; P=0.015). Acceptability was generally good (dropout rate of 9% in the RR group). CONCLUSIONS: A repeated reading intervention applied by parents may improve reading fluency of dyslexic children during summer vacation, with a good acceptability. Further studies are needed to confirm these findings.

Phonological processing skills in children with speech sound disorder: A multiple case study approach.

BACKGROUND: Children with speech sound disorder (SSD) are at increased risk of reading difficulties due to poor phonological processing skills. However, the extent to which children with SSD demonstrate weaknesses on specific or all phonological processing tasks is not well understood. AIMS: To examine the phonological processing abilities of a clinically identified sample of children with SSD, with and without reading difficulties. To determine the extent to which the proportion of children with concomitant SSD and reading difficulties exhibited weaknesses in specific areas of phonological processing, or a more general phonological deficit. METHODS & PROCEDURES: Data were obtained from 157 school-aged children (Mage = 77 months, SD = 7.01) in receipt of school-based speech therapy. Approximately 25% of the sample was identified as poor readers, based on a standardized measure of word decoding. We compared the proportion of children who scored at or below 1 SD below the mean, or the bottom 16th percentile, on measures of phonological awareness, rapid automatized naming and verbal short-term memory among those identified as poor readers and good readers. OUTCOMES & RESULTS: Children with SSD demonstrated a range of phonological processing difficulties, particularly on the measure of verbal short-term memory. No specific skill differentiated groups of children with SSD with and without reading difficulties; however, those classified as poor readers on the word-decoding measure exhibited more widespread difficulties, even after controlling for language ability. CONCLUSIONS & IMPLICATIONS: Results support a cumulative risk model such that children with SSD and reading difficulties are likely to demonstrate generally poor phonological processing abilities. WHAT THIS PAPER ADDS: What is already known on the subject Children with SSD are at heightened risk of reading difficulties, particularly if their SSD persists into school age. However, not all children with SSD experience reading problems. Research aimed at determining which children are at the highest risk is mixed as to how best to identify which children with SSD are most likely to experience reading difficulties. What this paper adds to existing knowledge The study used a multiple case study approach to determine if performance on phonological processing skills might differentiate children with SSD who were poor readers from those who were good readers. As a group, children with SSD exhibited poor verbal short-term memory but relatively intact rapid automatized naming skills. No one phonological processing skill differentiated children who were poor readers from good readers. However, children with reading difficulties appeared to experience more general difficulties across phonological processing tasks, even after controlling for language abilities. What are the potential or actual clinical implications of this work? A single deficit (i.e., speech sound production) is not sufficient data to make a complete diagnosis or treatment decisions. Multiple sources of data, including several aspects of phonological processing, should be obtained to understand reading risk in children with SSD.

Neural synchronization and intervention in pre-readers who later on develop dyslexia.

A growing number of studies has investigated temporal processing deficits in dyslexia. These studies largely focus on neural synchronization to speech. However, the importance of rise times for neural synchronization is often overlooked. Furthermore, targeted interventions, phonics-based and auditory, are being developed, but little is known about their impact. The current study investigated the impact of a 12-week tablet-based intervention. Children at risk for dyslexia received phonics-based training, either with (n = 31) or without (n = 31) auditory training, or engaged in active control training (n = 29). Additionally, neural synchronization and processing of rise times was longitudinally investigated in children with dyslexia (n = 26) and typical readers (n = 52) from pre-reading (5 years) to beginning reading age (7 years). The three time points in the longitudinal study correspond to intervention pre-test, post-test and consolidation, approximately 1 year after completing the intervention. At each time point neural synchronization was measured to sinusoidal stimuli and pulsatile stimuli with shortened rise times at syllable (4 Hz) and phoneme rates (20 Hz). Our results revealed no impact on neural synchronization at syllable and phoneme rate of the phonics-based and auditory training. However, we did reveal atypical hemispheric specialization at both syllable and phoneme rates in children with dyslexia. This was detected even before the onset of reading acquisition, pointing towards a possible causal rather than consequential mechanism in dyslexia. This study contributes to our understanding of the temporal processing deficits underlying the development of dyslexia, but also shows that the development of targeted interventions is still a work in progress.

Educational Technology in Support of Elementary Students With Reading or Language-Based Disabilities: A Cluster Randomized Control Trial.

Experts laud the potential of educational technology (edtech) to promote reading among students with disabilities, but supporting evidence is lacking. This study evaluated the effectiveness of the Lexia® Core5® Reading edtech program (Core5) on the Measures of Academic Progress® (MAP) Growth Reading™ and easyCBM oral reading fluency performance of students with reading or language-based disabilities in Grades K to 5. Core5 systematically addresses multiple reading domains and previously was effective in general education. We hypothesized treatment students using Core5 would outperform controls on the reading assessments. This was a cluster randomized effectiveness evaluation, with condition assignment by school (three treatment and two business-as-usual control schools). Participating students in Grades K to 5 (N = 115; nTreatment = 65) were flagged by their Chicago-area district as needing reading intervention and had Individualized Education Program (IEP) designations of specific learning disability, speech or language impairment, or developmental delay. Treatment students used Core5 to supplement Tier 1 instruction for an average of 58.76 minutes weekly for 24.58 weeks. Regressions revealed treatment students outperformed controls on MAP (B = 3.85, CI = 0.57-7.13, p = .022, d = .24), but there were no differences for oral reading fluency. MAP findings confirm edtech can effectively supplement reading instruction for this population.