Targeting Personal Recovery of People With Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centered Design.

Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely "patient." Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the "problem" was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled "This is Me" (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.

The interplay of socio-economic status represented by paternal educational level, white matter structure and reading.

A child's school achievement is influenced by environmental factors. The environmental factors, when represented by socio-economic status (SES) of the family, have been demonstrated to be related to the reading skills of a child. The neural correlates of the relation between SES and reading have been less thoroughly investigated. The present study expands current research by exploring the relation between SES, quantified by paternal educational level, reading of the offspring and the structure of white matter pathways in the left hemisphere as derived from DTI-based tractography analyses. Therefore, three dorsal white matter pathways, i.e. the long, anterior and posterior segments of the arcuate fasciculus (AF), and three ventral white matter pathways, i.e. the inferior fronto-occipital fasciculus (IFOF), the inferior longitudinal fasciculus (ILF) and the uncinate fasciculus (UF), were manually dissected in the left hemisphere of 34 adolescents with a wide range of reading skills. The results demonstrated a relation between word reading, SES quantified by paternal educational level, and fractional anisotropy (FA) within the left dorsal AF segment and the left ventral UF. Thus, the present study proposes a relationship between paternal educational level and a specific white matter pathway that is important for reading, aiming to guide future research that can determine processes underlying this relationship.

N1 lateralization and dyslexia: An event-related potential study in children with a familial risk of dyslexia.

The rapid automatic specialized processing of printed words is signalled by the left-lateralization of the N1 component in the visual event-related potential (ERP). In the present study, we have investigated whether differences in N1 lateralization can be observed between Dutch children with and without (a familial risk of) dyslexia around the age of 12 years using a linguistic judgement task. Forty-five participants were included in the ERP analysis, 18 in the low familial risk group without dyslexia, 15 in the high familial risk group without dyslexia, and 12 in the high familial risk group with dyslexia. The results showed that although the N1 peaked slightly earlier in the left hemisphere, the N1 amplitude was right-lateralized in all groups. Moreover, there were no group differences in N1 amplitude or latency, and there was no relationship between reading (related) test scores and N1 characteristics. The results of the present study and our previous findings in adults suggest that print-tuning lateralization is a process that is still developing in adolescence. Because other studies did find N1 lateralization in younger readers with a print versus nonprint contrast, the current results seem to indicate that differences in N1 lateralization also depend on the experimental paradigm.

Predictors for grade 6 reading in children at familial risk of dyslexia.

The present study investigates whether grade 6 reading outcomes, reading fluency, and reading comprehension can be predicted by grade 3 reading fluency, familial risk of dyslexia (FR), and grade 3 reading related skills: rapid automatized naming (RAN), phonological awareness (PA), and vocabulary. In a sample of 150 children, of whom 83 had a parent with dyslexia, correlation and regression analyses were performed. FR, measured on a continuous scale, was by itself related to all outcomes. However, FR did not explain any variance on top of grade 3 reading fluency. Grade 3 reading fluency strongly predicted grade 6 reading fluency and was also related to reading comprehension. RAN improved the prediction of grade 6 reading fluency, though the additional explained variance was small. Vocabulary and PA fully explained the variance that grade 3 reading fluency explained in grade 6 reading comprehension. Vocabulary explained a substantial amount of variance in grade 6 reading comprehension making it an interesting clinical target. As we used continuous measures of reading fluency and FR, our findings are not biased by distinct diagnostic criteria.

L1 and L2 reading skills in Dutch adolescents with a familial risk of dyslexia.

BACKGROUND: The present study investigated differences in reading and spelling outcomes in Dutch and English as a second language (ESL) in adolescents with a high familial risk of dyslexia, of whom some have developed dyslexia (HRDys) while others have not (HRnonDys), in comparison to a low familial risk control group without dyslexia (LRnonDys). This allowed us to investigate the persistence of dyslexia in the first language (L1) and the effect of dyslexia on the second language (L2), which has, in this case, a lower orthographic transparency. Furthermore, the inclusion of the HRnonDys group allowed us to investigate the continuity of the familial risk of dyslexia, as previous studies observed that the HRnonDys group often scores in between the HRDys and LRnonDys group, and whether these readers without reading deficits in Dutch, have more reading difficulties in ESL. METHODS: The data of three groups of adolescents were analyzed; 27 LRnonDys, 25 HRdys 25 HRnonDys. The mean age was 14;1 years; months, and 37 were male. All were native speakers of Dutch, attended regular secondary education (grade 7-10), and were non-native speakers of English. Using MANOVA the groups were compared on Dutch and English word reading fluency (WRF), spelling and vocabulary, Dutch pseudoword and loanword reading fluency, phonological awareness (PA), rapid automatized naming (RAN), and verbal short term and working memory. A repeated measures ANOVA was used to compare English and Dutch WRF, spelling and vocabulary directly within the three groups. RESULTS: The analyses revealed that the HRDys group had a deficit in both reading and spelling in Dutch and ESL. They also performed poorer than the LRnonDys group on all other measures. Effect sizes were especially large for pseudoword reading and the reaction times during the PA task. The HRnonDys group scored generally poorer than the LRnonDys group but this difference was only significant for Dutch pseudoword reading, PA reaction times and verbal short term memory. In general the HRDys and HRnonDys group scored similar in Dutch and English, except for English WRF where the HRDys group scored slightly better than expected based on their Dutch WRF. DISCUSSION: There was a high persistence of dyslexia. Adolescents with dyslexia had large impairments in reading and spelling, and reading related measures, both in Dutch and ESL. Despite high inter-individual differences, an overall three-step pattern was observed. Adolescents in the HRnonDys group scored in between the HRDys and LRnonDys group, supporting the polygenetic origin of dyslexia and the continuity of the familial risk of dyslexia. The lower orthographic transparency did not have a negative effect on L2 reading, spelling and vocabulary, both in the HRnonDys and HRDys group. The latter group performed slightly better than expected in L2, which may be a result of the massive exposure to English and high motivation to use English by adolescents.

The Role of Categorical Speech Perception and Phonological Processing in Familial Risk Children With and Without Dyslexia.

Purpose: This study assessed whether a categorical speech perception (CP) deficit is associated with dyslexia or familial risk for dyslexia, by exploring a possible cascading relation from speech perception to phonology to reading and by identifying whether speech perception distinguishes familial risk (FR) children with dyslexia (FRD) from those without dyslexia (FRND). Method: Data were collected from 9-year-old FRD (n = 37) and FRND (n = 41) children and age-matched controls (n = 49) on CP identification and discrimination and on the phonological processing measures rapid automatized naming, phoneme awareness, and nonword repetition. Results: The FRD group performed more poorly on CP than the FRND and control groups. Findings on phonological processing align with the literature in that (a) phonological processing related to reading and (b) the FRD group showed the lowest phonological processing outcomes. Furthermore, CP correlated weakly with reading, but this relationship was fully mediated by rapid automatized naming. Conclusion: Although CP phonological skills are related to dyslexia, there was no strong evidence for a cascade from CP to phonology to reading. Deficits in CP at the behavioral level are not directly associated with dyslexia.

Dichotic listening as an index of lateralization of speech perception in familial risk children with and without dyslexia.

Atypical language lateralization has been marked as one of the factors that may contribute to the development of dyslexia. Indeed, atypical lateralization of linguistic functions such as speech processing in dyslexia has been demonstrated using neuroimaging studies, but also using the behavioral dichotic listening (DL) method. However, so far, DL results have been mixed. The current study assesses lateralization of speech processing by using DL in a sample of children at familial risk (FR) for dyslexia. In order to determine whether atypical lateralization of speech processing relates to reading ability, or is a correlate of being at familial risk, the current study compares the laterality index of FR children who did and did not become dyslexic, and a control group of readers without dyslexia. DL was tested in 3rd grade and in 5/6th grade. Results indicate that at both time points, all three groups have a right ear advantage, indicative of more pronounced left-hemispheric processing. However, the FR-dyslexic children are less good at reporting from the left ear than controls and FR-nondyslexic children. This impediment relates to reading fluency.

Print-Tuning Lateralization and Handedness: an Event-Related Potential Study in Dyslexic Higher Education Students.

Despite their ample reading experience, higher education students with dyslexia still show deficits in reading and reading-related skills. Lateralized print tuning, the early sensitivity to print of the left parietal cortex signalled by the N1 event-related potential (ERP) component, differs between beginning dyslexic readers and controls. For adults, the findings are mixed. The present study aims to investigate whether print tuning, as indexed by the N1 component, differs between 24 students with dyslexia and 15 non-dyslexic controls. Because handedness has been linked to lateralization, first, a separate analysis was conducted including only right-handed participants (n = 12 in both groups), like in most previous studies. ERPs were measured during a judgement task, requiring visual, phonological, or semantic judgments. In both groups, the N1 was earlier and stronger in the left than in the right hemisphere. However, when only strongly right-handed participants were evaluated, the N1 was less left-lateralized for participants with dyslexia as compared with controls. Participants with dyslexia had longer reaction times during the ERP experiment and performed worse on many reading (-related) tasks. These findings suggest that abnormal print tuning can still be found among higher education students with dyslexia and that handedness should be regarded in the study of print tuning.