[Place of the BMT-i modular tool in the assessment of learning disabilities]. / Place de l'outil modulable BMT-i dans l'évaluation des troubles de l'apprentissage.

PLACE OF THE BMT-I MODULAR TOOL IN THE ASSESSMENT OF LEARNING DISABILITIES Twenty percent of children have difficulties learning to read, write, or count. Eight percent of children have a specific and durable impairment in the development of a learning or cognitive function or Learning Disabilities (LD), often called «dys¼ (dysphasia, dyslexia, dysorthography, dyscalculia, dysgraphia, etc.). This is a public health problem, which has been addressed by the Haute Autorité de Santé (HAS), which recommends a health program based on the needs of each child, coordinating education and health professionals - rehabilitation specialists and medical prescribers. The role of the child's doctor is essential in the first line of action to identify these problems, to examine the child, to prescribe reeducation when necessary and to follow the evolution. However, he has received little training. The modular BMT-i (computerized adaptable test battery) tool is validated, easy to use and reliable. It allows the screening of difficulties in each domain in 10 to 25 minutes in front of a complaint by selecting the appropriate tests. A choice of clinical situations helps to understand the disorders and the approach of the examination of the child, to inform the families of the results, to accompany them on the therapeutic project and to prescribe the care adapted to each situation.

PLACE DE L'OUTIL MODULABLE BMT-I DANS L'ÉVALUATION DES TROUBLES DE L'APPRENTISSAGE Vingt pour cent des enfants sont en difficulté pour apprendre à lire, écrire et/ou compter. Huit pour cent des enfants présentent une altération durable et spécifique du développement d'un apprentissage ou d'une fonction cognitive (« troubles spécifiques du langage et des apprentissages ¼ [TSLA]), souvent simplifié sous le terme « dys ¼ (dysphasie, dyslexie, dysorthographie, dyscalculie, dysgraphie, etc.). La Haute Autorité de santé s'est saisie de ce problème de santé publique et recommande un parcours de santé ciblé sur les besoins de chaque enfant, coordonnant professionnels de l'éducation et de la santé ­ rééducateurs et médecins prescripteurs. Le rôle du médecin est essentiel en premier recours pour identifier les enfants concernés, les examiner, prescrire les rééducations nécessaires et suivre l'évolution. L'outil modulable BMT-i (batterie modulable de tests informatisée) validé, simple d'utilisation et fiable, permet le dépistage des difficultés dans chaque domaine en dix à vingt-cinq minutes, en sélectionnant les épreuves adéquates. Un choix de situations cliniques aide à la compréhension des troubles et à la démarche de l'examen de l'enfant, afin d'informer les familles des résultats, les accompagner dans les actions à mener et prescrire les soins adaptés à chaque situation.

External Validation of BMT-i Computerized Test Battery for Diagnosis of Learning Disabilities.

Background: Learning disabilities (LDs) are a major public health issue, affecting cognitive functions and academic performance for 8% of children. If LDs are not detected early and addressed through appropriate interventions, they have a heavy impact on these children in the social, educational, and professional spheres, at great cost to society. The BMT-i (Batterie Modulable de Tests informatisée, or "computerized Adaptable Test Battery") enables fast, easy, reliable assessments for each cognitive domain. It has previously been validated in children ages 4-13 who had no prior complaints. The present study demonstrates the sensitivity of the BMT-i, relative to reference test batteries, for 191 children with cognitive difficulties. Materials and Methods: These 191 subjects were included in the study by the 14 pediatricians treating them for complaints in five cognitive domains: written language [60 (cases)]; mathematical cognition (40); oral language (60); handwriting, drawing, and visuospatial construction (45); and attention and executive functioning (45). In accordance with a predefined protocol, the children were administered BMT-i tests first, by their pediatricians, and reference tests later, by specialists to whom the BMT-i test results were not disclosed. Comparison of BMT-i and reference test results made it possible to evaluate sensitivity and agreement between tests. Results: For each of the five domains, the BMT-i was very sensitive (0.91-1), and normal BMT-i results were highly predictive of normal results for specialized reference tests [negative likelihood ratio (LR-): 0-0.16]. There was close agreement between BMT-i and reference tests in all domains except attention and executive functioning, for which only moderate agreement was observed. Conclusion: The BMT-i offers rapid, reliable, simple computerized assessments whose sensitivity and agreement with reference test batteries make it a suitable first-line instrument for LD screening in children 4-13 years old.

The Computerized Adaptable Test Battery (BMT-i) for Rapid Assessment of Children's Academic Skills and Cognitive Functions: A Validation Study.

Background: Learning disabilities in children are a major public health concern worldwide, having a prevalence of 8%. They are associated with lost social, educational, and ultimately, professional opportunities for individuals. These disabilities are also very costly to governments and raise the issue of the appropriate means of screening. Unfortunately, validated tools for preliminary appraisal of learning and cognitive function in struggling children are presently restricted to specific age ranges and cognitive domains. This study sought to validate a first-line battery for assessment of academic skills and cognitive functions. Materials and Methods: The computerized Adaptable Test Battery, or BMT-i, includes a panel of tests for the first-line assessment of children's academic skills and cognitive functions. The tests reflect expected abilities for the age group in question, exploring academic skills (written language and mathematical cognition) and cognitive domains (verbal, non-verbal, and attentional/executive functions). The authors relied on the results of these tests for a sample of 1,074 Francophone children representative of the mainland French school-age population (522 boys and 552 girls, ages 4-13, from 39 classes at 7 public and 5 private schools). Thirteen speech-language pathologists and neuropsychologists individually administered the tests. Results: The psychometric characteristics of the empirical data obtained showed acceptable to good test homogeneity, internal consistency (Cronbach's alpha: > 0.70), test-retest reliability (intraclass correlation coefficients: ~0.80), and consistency with reference test batteries (r: 0.44-0.96). Conclusion: The BMT-i was validated in a large sample of children in mainstream French schools, paving the way for its use in first-line screening of learning disabilities among children with complaints, whether their learning difficulties have been flagged by their parents or by their teachers.

Asymmetrical interference between number and item size perception provides evidence for a domain specific impairment in dyscalculia.

Dyscalculia, a specific learning disability that impacts arithmetical skills, has previously been associated to a deficit in the precision of the system that estimates the approximate number of objects in visual scenes (the so called 'number sense' system). However, because in tasks involving numerosity comparisons dyscalculics' judgements appears disproportionally affected by continuous quantitative dimensions (such as the size of the items), an alternative view linked dyscalculia to a domain-general difficulty in inhibiting task-irrelevant responses. To arbitrate between these views, we evaluated the degree of reciprocal interference between numerical and non-numerical quantitative dimensions in adult dyscalculics and matched controls. We used a novel stimulus set orthogonally varying in mean item size and numerosity, putting particular attention into matching both features' perceptual discriminability. Participants compared those stimuli based on each of the two dimensions. While control subjects showed no significant size interference when judging numerosity, dyscalculics' numerosity judgments were strongly biased by the unattended size dimension. Importantly however, both groups showed the same degree of interference from the unattended dimension when judging mean size. Moreover, only the ability to discard the irrelevant size information when comparing numerosity (but not the reverse) significantly predicted calculation ability across subjects. Overall, our results show that numerosity discrimination is less prone to interference than discrimination of another quantitative feature (mean item size) when the perceptual discriminability of these features is matched, as here in control subjects. By quantifying, for the first time, dyscalculic subjects' degree of interference on another orthogonal dimension of the same stimuli, we are able to exclude a domain-general inhibition deficit as explanation for their poor / biased numerical judgement. We suggest that enhanced reliance on non-numerical cues during numerosity discrimination can represent a strategy to cope with a less precise number sense.