Screening for Dyslexia in University Students: a Standardized Procedure Based on Conditional Inference Trees.

OBJECTIVE: The focus of this study is on providing tools to enable researchers and practitioners to screen for dyslexia in adults entering university. The first aim is to validate and provide diagnostic properties for a set of seven tests including a 1-min word reading test, a 2-min pseudoword reading test, a phonemic awareness test, a spelling test, the Alouette reading fluency test, a connected-text reading fluency test, and the self-report Adult Reading History Questionnaire (ARHQ). The second, more general, aim of this study was to devise a standardized and confirmatory procedure for dyslexia screening from a subset of the initial seven tests. We used conditional inference tree analysis, a supervised machine learning approach to identify the most relevant tests, cut-off scores, and optimal order of test administration. METHOD: A combined sample of 60 university students with dyslexia (clinical validation group) and 65 university students without dyslexia (normative group) provided data to determine the diagnostic properties of these tests including sensitivity, specificity, and cut-off scores. RESULTS: Results showed that combinations of four tests (ARHQ, text reading fluency, phonemic awareness, pseudoword reading) and their relative conditional cut-off scores optimize powerful discriminatory screening procedures for dyslexia, with an overall classification accuracy of approximately 90%. CONCLUSIONS: The novel use of the conditional inference tree methodology explored in the present study offered a way of moving toward a more efficient screening battery using only a subset of the seven tests examined. Both clinical and theoretical implications of these findings are discussed.

Phoneme Representation and Articulatory Impairment: Insights from Adults with Comorbid Motor Coordination Disorder and Dyslexia.

Phonemic processing skills are impaired both in children and adults with dyslexia. Since phoneme representation development is based on articulatory gestures, it is likely that these gestures influence oral reading-related skills as assessed through phonemic awareness tasks. In our study, fifty-two young dyslexic adults, with and without motor impairment, and fifty-nine skilled readers performed reading, phonemic awareness, and articulatory tasks. The two dyslexic groups exhibited slower articulatory rates than skilled readers and the comorbid dyslexic group presenting with an additional difficulty in respiratory control (reduced speech proportion and increased pause duration). Two versions of the phoneme awareness task (PAT) with pseudoword strings were administered: a classical version under time pressure and a delayed version in which access to phonemic representations and articulatory programs was facilitated. The two groups with dyslexia were outperformed by the control group in both versions. Although the two groups with dyslexia performed equally well on the classical PAT, the comorbid group performed significantly less efficiently on the delayed PAT, suggesting an additional contribution of articulatory impairment in the task for this group. Overall, our results suggest that impaired phoneme representations in dyslexia may be explained, at least partially, by articulatory deficits affecting access to them.

Tracking reading skills and reading-related skills in dyslexia before (age 5) and after (ages 10-17) diagnosis.

This study had three goals: to examine the stability of deficits in the phonological and lexical routes in dyslexia (group study), to determine the prevalence of dyslexia profiles (multiple-case study), and to identify the prediction of phonemic segmentation and discrimination skills before reading acquisition on future reading level. Among a group of 373 non-readers seen at age 5, 38 students were subsequently diagnosed as either consistent dyslexic readers (18 DYS) or consistent typical readers (20 TR). Their phonological and lexical reading skills were assessed at ages 10 and 17 and their phonemic segmentation and discrimination skills at age 5. In comparison with TR of the same chronological age (CA-TR), individuals with dyslexia demonstrated an impairment of the two reading routes, especially of the phonological reading route. In the comparison with younger TR (age 10) of the same reading level (RL-TR), only a deficit of the phonological route is observed. In the multiple-case study, the comparisons with CA-TR showed a prevalence of mixed profiles and very few dissociated profiles, whereas the comparison with RL-TR resulted mostly in two profiles depending on the measure: a phonological profile when accuracy was used and a delayed profile when speed was used. In addition, the correlations between early phonemic segmentation and discrimination skills (age 5) and later reading skills (age 17) were significant, and in the group of individuals with dyslexia, early phonemic segmentation skills significantly predicted these later reading skills. Phonological reading deficits are persistent and mainly caused by early phonemic impairments.

Text Reading Fluency and Text Reading Comprehension Do Not Rely on the Same Abilities in University Students With and Without Dyslexia.

Developmental dyslexia is a specific learning condition characterized by severe and persistent difficulties in written word recognition, decoding and spelling that may impair both text reading fluency and text reading comprehension. Despite this, some adults with dyslexia successfully complete their university studies even though graduating from university involves intensive exposure to long and complex texts. This study examined the cognitive skills underlying both text reading comprehension and text reading fluency (TRF) in a sample of 54 university students with dyslexia and 63 university students without dyslexia, based on a set of tests adapted for an adult population, including listening comprehension, word reading, pseudoword reading (i.e., decoding), phonemic awareness, spelling, visual span, reading span, vocabulary, non-verbal reasoning, and general knowledge. The contribution of these skills to text reading fluency and text reading comprehension was examined using stepwise multiplicative linear regression analyses. As far as TRF is concerned, a regression model including word reading, pseudoword reading and spelling best fits the data, while a regression model including listening comprehension, general knowledge and vocabulary best fits the data obtained for text reading comprehension. Overall, these results are discussed in the light of the current literature on adults with dyslexia and both text reading fluency and text reading comprehension.

A sensorimotor representation impairment in dyslexic adults: A specific profile of comorbidy.

Sensorimotor disorders have been frequently reported in children and adults with dyslexia over the past 30 years. The present study aimed to determine the impact of sensorimotor comorbidity risks in dyslexia by investigating the functional links between phonological and sensorimotor representations in young dyslexic adults. Using 52 dyslexic participants and 58 normo-readers, we investigated whether the underlying phonological deficit, which is reported in the literature, was associated with a general impairment of sensorimotor representations of articulatory and bodily actions. Internal action representations were explored through motor imagery tasks, consisting of measuring and comparing the durations of performed or imagined actions chosen from their current repertoire of daily life activities. To detect sensorimotor deficits, all participants completed the extended version of the M-ABC 2, as a reference test. We found sensorimotor impairments in 27% of the young adult dyslexics, then considered as sensorimotor comorbid, as opposed to much less in the normo-reader group (5%). While motor slowdown, reflecting motor difficulty, was present in all dyslexic adults, motor imagery performance was impacted only in the specific dyslexic subgroup with sensorimotor impairments. Moreover, in contrast with slowness, only the comorbid subgroup showed an increased variability in execution durations. The present study highlights the importance of the quality of perception-action coupling, questions the relevance of investigating sensorimotor impairment profiles beyond phonological deficits and provides new arguments supporting the perspective of multiple deficits approaches in dyslexia.

Activation time-course of phonological code in silent word recognition in adult readers with and without dyslexia.

In skilled adult readers, reading words is generally assumed to rapidly and automatically activate the phonological code. In adults with dyslexia, despite the main consensus on their phonological processing deficits, little is known about the activation time course of this code. The present study investigated this issue in both populations. Participants' accuracy and eye movements were recorded while they performed a visual lexical decision task in which phonological consistency of written words was manipulated. Readers with dyslexia were affected by phonological consistency during second fixation duration of visual word recognition suggesting a late activation of the phonological code. Regarding skilled readers, no influence of phonological consistency was found when the participants were considered a homogeneous population. However, a different pattern emerged when they were divided into two subgroups according to their phonological and semantic abilities: Those who showed better decoding than semantic skills were affected by phonological consistency at the earliest stage of visual word recognition while those who showed better semantic than decoding skills were not affected by this factor at any processing stage. Overall, the findings suggest that the presence of phonological deficits in readers with dyslexia is associated with a delayed activation of phonological representations during reading. In skilled readers, the contribution of phonology varies with their reading profile, i.e., being phonologically or semantically oriented.

Semantic compensation and novel word learning in university students with dyslexia.

The aim of this experiment was to use behavioral and electrophysiological methods to compare university students with dyslexia and matched skilled readers in a novel word learning experiment that included phonological categorization tasks, a word learning phase and a test phase with matching and semantic tasks. Specifically, we aimed at disentangling two hypotheses. If phonological processing drives novel word learning and if phonological processing is impaired in students with dyslexia, they should perform lower than skilled readers not only in the phonological categorization tasks but also in the matching and semantic tasks. By contrast, if students with dyslexia use semantic knowledge to compensate for their phonological deficits, should be able to reach the same level of performance and show similar enhancements of the N200 and N400 components than skilled readers in the matching and semantic tasks. Results at both behavioral and electrophysiological levels showed that the phonological deficits evidenced in the phonological tasks did not impede students with dyslexia to learn the meaning of novel words, possibly because they mobilized more frontal resources than skilled readers. These results are discussed within a general framework of semantic compensation in adults with dyslexia.

E-book reading hinders aspects of long-text comprehension for adults with dyslexia.

Developmental dyslexia is a long-lasting reading deficit that persists into adulthood. In spite of many difficulties, some adults with dyslexia reach levels of reading comprehension similar to those of unimpaired readers and successfully study at university. While digital technologies offer many potential tools to facilitate reading, there are differences between printed books and e-books, particularly regarding the interaction between the reader and the text (paratextual cues). This study used long-text reading to investigate (1) different aspects of reading comprehension skills (literal and inferential processes, location of events within a story, and reconstruction of the plot) among university students with dyslexia and (2) the impact of e-book reading on reading comprehension in this population. Thirty adults with dyslexia and 30 matched skilled readers read the same text presented from a printed book and an e-book (Amazon Kindle). Questions were open-ended and both questions and answers used oral format. Results showed that with the printed book, dyslexic adults performed similarly to skilled readers in both literal and inferential reading comprehension tasks. Moreover, they performed at the same level or higher than skilled readers in tasks assessing spatiotemporal aspects of reading (localization of events and plot reconstruction). Conversely, with the e-book reader, the dyslexic adults were outperformed by skilled readers both in literal and spatiotemporal comprehension tasks. These results suggest that reading from an e-book hinders some aspects of reading comprehension for adults with dyslexia. However, when reading a printed book without time pressure, university students with dyslexia performed as well as, or better than, non-impaired readers on some measures of reading comprehension. Therefore, digital reading devices might not always be advantageous to them.

Evidencing the developmental shift from reactive to proactive control in early childhood and its relationship to working memory.

As they age, children tend to get more effective at regulating their behavior in complex situations; this improvement in cognitive control is often interpreted as a shift from predominantly reactive control to proactive control. There are three issues with this interpretation. First, hard evidence is lacking that younger children actually rely on reactive control. Second, the precise age range when such a shift would occur is still unclear. Third, the reasons for this shift have not been explored. In the current study, we tested the hypothesis that children under 5 years of age do rely on reactive control, that they progressively shift to proactive control with age, and that this shift is related to increases in working memory capacity (which is necessary for proactive control). Children aged 4 to 7 years performed a cognitive control task, the AX-CPT (AX-Continuous Performance Task), as well as verbal and visuospatial working memory tasks. Using the paradigmatic AX-CPT in this age range allowed us to observe, for the first time, an actual reactive pattern in children under 5 years of age. There was a progressive shift from reactive control to proactive control, with an estimated turning point between 5 and 6 years of age. The effect of age on proactive control was essentially shared with working memory capacity, confirming that these two cognitive processes develop in tandem.

What Is the Influence of Morphological Knowledge in the Early Stages of Reading Acquisition Among Low SES Children? A Graphical Modeling Approach.

Children from low-SES families are known to show delays in aspects of language development which underpin reading acquisition such as vocabulary and listening comprehension. Research on the development of morphological skills in this group is scarce, and no studies exist in French. The present study investigated the involvement of morphological knowledge in the very early stages of reading acquisition (decoding), before reading comprehension can be reliably assessed. We assessed listening comprehension, receptive vocabulary, phoneme awareness, morphological awareness as well as decoding, word reading and non-verbal IQ in 703 French first-graders from low-SES families after 3 months of formal schooling (November). Awareness of derivational morphology was assessed using three oral tasks: Relationship Judgment (e.g., do these words belong to the same family or not? heat-heater … ham-hammer); Lexical Sentence Completion [e.g., Someone who runs is a …? (runner)]; and Non-lexical Sentence Completion [e.g., Someone who lums is a…? (lummer)]. The tasks differ on implicit/explicit demands and also tap different kinds of morphological knowledge. The Judgement task measures the phonological and semantic properties of the morphological relationship and the Sentence Completion tasks measure knowledge of morphological production rules. Data were processed using a graphical modeling approach which offers key information about how skills known to be involved in learning to read are organized in memory. This modeling approach was therefore useful in revealing a potential network which expresses the conditional dependence structure between skills, after which recursive structural equation modeling was applied to test specific hypotheses. Six main conclusions can be drawn from these analyses about low SES reading acquisition: (1) listening comprehension is at the heart of the reading acquisition process; (2) word reading depends directly on phonemic awareness and indirectly on listening comprehension; (3) decoding depends on word reading; (4) Morphological awareness and vocabulary have an indirect influence on word reading via both listening comprehension and phoneme awareness; (5) the components of morphological awareness assessed by our tasks have independent relationships with listening comprehension; and (6) neither phonemic nor morphological awareness influence vocabulary directly. The implications of these results with regard to early reading acquisition among low SES groups are discussed.

Screening for Dyslexia in French-Speaking University Students: An Evaluation of the Detection Accuracy of the Alouette Test.

Developmental dyslexia is a lifelong impairment affecting 5% to 10% of the population. In French-speaking countries, although a number of standardized tests for dyslexia in children are available, tools suitable to screen for dyslexia in adults are lacking. In this study, we administered the Alouette reading test to a normative sample of 164 French university students without dyslexia and a validation sample of 83 students with dyslexia. The Alouette reading test is designed to screen for dyslexia in children, since it taps skills that are typically deficient in dyslexia (i.e., phonological skills). However, the test's psychometric properties have not previously been available, and it is not standardized for adults. The results showed that, on the Alouette test, dyslexic readers were impaired on measures of accuracy, speed, and efficiency (accuracy/reading time). We also found significant correlations between the Alouette reading efficiency and phonological efficiency scores. Finally, in terms of the Alouette test, speed-accuracy trade-offs were found in both groups, and optimal cutoff scores were determined with receiver operator characteristic curves analysis, yielding excellent discriminatory power, with 83.1% sensitivity and 100% specificity for reading efficiency. Thus, this study supports the Alouette test as a sensitive and specific screening tool for adults with dyslexia.

Letter and symbol identification: No evidence for letter-specific crowding mechanisms.

It has been proposed that letters, as opposed to symbols, trigger specialized crowding processes, boosting identification of the first and last letters of words. This hypothesis is based on evidence that single-letter accuracy as a function of within-string position has a W shape (the classic serial position function [SPF] in psycholinguistics) whereas an inverted V shape is obtained when measured with symbols. Our main goal was to test the robustness of the latter result. Our hypothesis was that any letter/symbol difference might result from short-term visual memory processes (due to the partial report [PR] procedures used in SPF studies) rather than from crowding. We therefore removed the involvement of short-term memory by precueing target-item position and compared SPFs with precueing and postcueing. Perimetric complexity was stringently matched between letters and symbols. In postcueing conditions similar to previous studies, we did not reproduce the inverted V shape for symbols: Clear-cut W shapes were observed with an overall smaller accuracy for symbols compared to letters. This letter/symbol difference was dramatically reduced in precueing conditions in keeping with our prediction. Our results are not consistent with the claim that letter strings trigger specialized crowding processes. We argue that PR procedures are not fit to isolate crowding processes.

Spatiotemporal reorganization of the reading network in adult dyslexia.

Developmental dyslexia is characterized by impairments in reading fluency and spelling that persist into adulthood. Here, we hypothesized that high-achieving adult dyslexics (i.e., university students with a history of dyslexia) manage to cope with these deficits by relying to a greater extent on morphological information than do non-impaired adult readers. We used magnetoencephalography (MEG) in a primed lexical decision task, in which we contrasted orthographic, morphological and semantic processing. Behavioral results confirmed that adult dyslexics did indeed rely to a greater extent on the semantic properties of morphemes than controls. In line with this, MEG results showed early morphological effects (100-200 msec) in a frontal network, which reflected the contribution of semantic processing. The same effects occurred much later in controls (∼400 msec). In contrast, controls showed early orthographic priming effects in posterior left inferior temporal gyrus (LITG) at around 130 msec, which were not seen in dyslexics. In the LITG, dyslexics showed only late activation of semantic and orthographic information. The present results suggest a spatiotemporal reorganization of the reading network, in which morphological information located in frontal regions is activated earlier in high-achieving adults dyslexics than controls.

Phonemic-Morphemic dissociation in university students with dyslexia: an index of reading compensation?

A phonological deficit constitutes a primary cause of developmental dyslexia, which persists into adulthood and can explain some aspects of their reading impairment. Nevertheless, some dyslexic adults successfully manage to study at university level, although very little is currently known about how they achieve this. The present study investigated at both the individual and group levels, whether the development of another oral language skill, namely, morphological knowledge, can be preserved and dissociated from the development of phonological knowledge. Reading, phonological, and morphological abilities were measured in 20 dyslexic and 20 non-dyslexic university students. The results confirmed the persistence of deficits in phonological but not morphological abilities, thereby revealing a dissociation in the development of these two skills. Moreover, the magnitude of the dissociation correlated with reading level. The outcome supports the claim that university students with dyslexia may compensate for phonological weaknesses by drawing on morphological knowledge in reading.

Spatiotemporal Dynamics of Morphological Processing in Visual Word Recognition.

The spatiotemporal dynamics of morphological, orthographic, and semantic processing were investigated in a primed lexical decision task in French using magnetoencephalography (MEG). The goal was to investigate orthographic and semantic contributions to morphological priming and compare these effects with pure orthographic and semantic priming. The time course of these effects was analyzed in anatomically defined ROIs that were selected according to previous MEG and fMRI findings. The results showed that morphological processing was not localized in one specific area but distributed over a vast network that involved left inferior temporal gyrus, left superior temporal gyrus, left inferior frontal gyrus, and left orbitofrontal gyrus. Second, all morphological effects were specific, that is, in none of the ROIs could morphology effects be explained by pure orthographic or pure semantic overlap. Third, the ventral route was sensitive to both the orthographic and semantic "part" of the morphological priming effect in the M350 time window. Fourth, the earliest effects of morphology occurred in left superior temporal gyrus around 250 msec and reflected the semantic contribution to morphological facilitation. Together then, the present results show that morphological processing is not just an emergent property of processing form or meaning and that semantic contributions to morphological facilitation can occur as early as 250 msec in the left superior temporal gyrus.

Vocabulary skills are well developed in university students with dyslexia: Evidence from multiple case studies.

Most studies in adults with developmental dyslexia have focused on identifying the deficits responsible for their persistent reading difficulties, but little is known on how these readers manage the intensive exposure to written language required to obtain a university degree. The main objective of this study was to identify certain skills, and specifically vocabulary skills, that French university students with dyslexia have developed and that may contribute to their literacy skills. We tested 20 university students with dyslexia and 20 normal readers (matched on chronological age, gender, nonverbal IQ, and level of education) in reading, phonological, vocabulary breadth (number of known words), and vocabulary depth (accuracy and precision) tasks. In comparing vocabulary measures, we used both Rasch model and single case study methodologies. Results on reading and phonological tasks confirmed the persistence of deficits in written word recognition and phonological skills. However, using the Rasch model we found that the two groups performed at the same level in the vocabulary breadth task, whereas dyslexics systematically outperformed their chronological age controls in the vocabulary depth task. These results are supplemented by multiple case studies. The vocabulary skills of French university students with dyslexia are well developed. Possible interpretations of these results are discussed.

Semantic processing during morphological priming: an ERP study.

Previous research has yielded conflicting results regarding the onset of semantic processing during morphological priming. The present study was designed to further explore the time-course of morphological processing using event-related potentials (ERPs). We conducted a primed lexical decision study comparing a morphological (LAVAGE - laver [washing - wash]), a semantic (LINGE - laver [laundry - wash]), an orthographic (LAVANDE - laver [lavender - wash]), and an unrelated control condition (HOSPICE - laver [nursing home - wash]), using the same targets across the four priming conditions. The behavioral data showed significant effects of morphological and semantic priming, with the magnitude of morphological priming being significantly larger than the magnitude of semantic priming. The ERP data revealed significant morphological but no semantic priming at 100-250 ms. Furthermore, a reduction of the N400 amplitude in the morphological condition compared to the semantic and orthographic condition demonstrates that the morphological priming effect was not entirely due to the semantic or orthographic overlap between the prime and the target. The present data reflect an early process of semantically blind morphological decomposition, and a later process of morpho-semantic decomposition, which we discuss in the context of recent morphological processing theories.

Cognitive flexibility predicts early reading skills.

An important aspect of learning to read is efficiency in accessing different kinds of linguistic information (orthographic, phonological, and semantic) about written words. The present study investigates whether, in addition to the integrity of such linguistic skills, early progress in reading may require a degree of cognitive flexibility in order to manage the coordination of this information effectively. Our study will look for evidence of a link between flexibility and both word reading and passage reading comprehension, and examine whether any such link involves domain-general or reading-specific flexibility. As the only previous support for a predictive relationship between flexibility and early reading comes from studies of reading comprehension in the opaque English orthography, another possibility is that this relationship may be largely orthography-dependent, only coming into play when mappings between representations are complex and polyvalent. To investigate these questions, 60 second-graders learning to read the more transparent French orthography were presented with two multiple classification tasks involving reading-specific cognitive flexibility (based on words) and non-specific flexibility (based on pictures). Reading skills were assessed by word reading, pseudo-word decoding, and passage reading comprehension measures. Flexibility was found to contribute significant unique variance to passage reading comprehension even in the less opaque French orthography. More interestingly, the data also show that flexibility is critical in accounting for one of the core components of reading comprehension, namely, the reading of words in isolation. Finally, the results constrain the debate over whether flexibility has to be reading-specific to be critically involved in reading.

Reading comprehension in a large cohort of French first graders from low socio-economic status families: a 7-month longitudinal study.

BACKGROUND: The literature suggests that a complex relationship exists between the three main skills involved in reading comprehension (decoding, listening comprehension and vocabulary) and that this relationship depends on at least three other factors orthographic transparency, children's grade level and socioeconomic status (SES). This study investigated the relative contribution of the predictors of reading comprehension in a longitudinal design (from beginning to end of the first grade) in 394 French children from low SES families. METHODOLOGY/PRINCIPAL FINDINGS: Reading comprehension was measured at the end of the first grade using two tasks one with short utterances and one with a medium length narrative text. Accuracy in listening comprehension and vocabulary, and fluency of decoding skills, were measured at the beginning and end of the first grade. Accuracy in decoding skills was measured only at the beginning. Regression analyses showed that listening comprehension and decoding skills (accuracy and fluency) always significantly predicted reading comprehension. The contribution of decoding was greater when reading comprehension was assessed via the task using short utterances. Between the two assessments, the contribution of vocabulary, and of decoding skills especially, increased, while that of listening comprehension remained unchanged. CONCLUSION/SIGNIFICANCE: These results challenge the 'simple view of reading'. They also have educational implications, since they show that it is possible to assess decoding and reading comprehension very early on in an orthography (i.e., French), which is less deep than the English one even in low SES children. These assessments, associated with those of listening comprehension and vocabulary, may allow early identification of children at risk for reading difficulty, and to set up early remedial training, which is the most effective, for them.

Perception of speech features by French-speaking children with cochlear implants.

PURPOSE: The present study investigates the perception of phonological features in French-speaking children with cochlear implants (CIs) compared with normal-hearing (NH) children matched for listening age. METHOD: Scores for discrimination and identification of minimal pairs for all features defining consonants (e.g., place, voicing, manner, nasality) and vowels (e.g., frontness, nasality, aperture) were measured in each listener. RESULTS: The results indicated no differences in "categorical perception," specified as a similar difference between discrimination and identification between CI children and controls. However, CI children demonstrated a lower level of "categorical precision," that is, lesser accuracy in both feature identification and discrimination, than NH children, with the magnitude of the deficit depending on the feature. CONCLUSIONS: If sensitive periods of language development extend well beyond the moment of implantation, the consequences of hearing deprivation for the acquisition of categorical perception should be fairly important in comparison to categorical precision because categorical precision develops more slowly than categorical perception in NH children. These results do not support the idea that the sensitive period for development of categorical perception is restricted to the first 1-2 years of life. The sensitive period may be significantly longer. Differences in precision may reflect the acoustic limitations of the cochlear implant, such as coding for temporal fine structure and frequency resolution.