A Delphi study exploring the barriers to dyslexia diagnosis and support: A parent's perspective.

The Rose Report (Rose, Independent review of the primary curriculum (England); 2009) outlined a set of recommendations for the management of dyslexia in the United Kingdom after a range of issues were found. Despite these recommendations, recent reports indicate that issues are still prevalent in the diagnosis process and support offered for dyslexic children. The Delphi method was employed to gain parental consensus as to the most significant barriers to diagnosis and delivery of support for children with dyslexia, as well as solutions to overcoming these barriers. Parents of primary school children with dyslexia were recruited for the study and were presented with a three round iterative questionnaire surrounding their experience of their child's dyslexia management. Parents' experiences of their child's diagnosis were explored to provide a first-hand account of the diagnosis procedure. Two overarching issues were identified: parents perceive that teachers have a lack of training around dyslexia, both initially and from continued professional development, and parents believe there is insufficient funding for dyslexia in schools and local authorities. Overall, the study indicated that better guidance is needed to ensure that reform and spending leads to tangible change in the identification of dyslexia and provision of support for children with dyslexia in primary education in the United Kingdom.

The contributions of decoding skill and lexical knowledge to the development of irregular word reading.

Two recent computational models of reading development propose that irregular words are read using a combination of decoding and lexical knowledge but differ in assumptions about how these sources of information interact and about the relative importance of different aspects of lexical knowledge. We report developmental data that help to adjudicate these differences. Study 1 adopted a correlational approach to investigate the item-level relations between the ability to read a word aloud, general decoding ability, and knowledge of the word's phonological form (lexical phonology) or meaning (lexical semantics). We found that the latter three factors all influenced accuracy of oral reading. We observed trends indicating that the impact of differences in decoding skill and lexical knowledge were more prominent for irregular words. Study 2 comprised two experiments in which novel irregular words were taught; in Experiment 1 we compared phonological to no pretraining, whereas in Experiment 2 we compared phonological to phonological plus semantics pretraining. Exposure to the phonological form of the word had a substantial impact in the early stages of learning, whereas the impact of adding semantics was more modest and emerged later. Our findings provide strong evidence that irregular words are read using a combination of decoding and lexical knowledge, with a greater contribution from lexical phonology than lexical semantics. Computational models of learning to read are currently unable to fully account for our data, therefore we propose some modifications. We advocate an instructional approach whereby phonics and vocabulary teaching are combined to support irregular word reading. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mini-Open Achilles Repair With a Flat Braided Suture in a Low-Profile Configuration.

Achilles repair has evolved over the past 30 years, from large open procedures with high complication rates to shorter, less-invasive procedures with better outcomes. Percutaneous repair has comparable failure rates with open repairs, fewer complications, and faster recovery. However, percutaneous Achilles repairs risk sural nerve injury. A mini-open repair fuses the gap between percutaneous and open procedures, and this approach has the potential to mitigate nerve injury while maintaining the increased efficiency in procedure time and patient recovery. The purpose of this Technical Note and accompanying video is to outline the repair of the Achilles tendon using a mini open repair using a low-profile flat braided suture.

Stemless Total Shoulder Arthroplasty With Orthobiologic Augmentation.

Total shoulder arthroplasty (TSA) has evolved over the years and is used for a variety of indications, with arthritis being the most common. Stemless TSA is a unique bone-preserving design that can eliminate rotational malalignment. Additionally, recent literature has found utility in the use of biological mesh and a platelet-rich plasma injection to improve healing. The purpose of this article is to outline the process of TSA using a stemless system and how to incorporate the use of amnion matrix and platelet-rich plasma into the surgical technique.

Microalgae-blend tilapia feed eliminates fishmeal and fish oil, improves growth, and is cost viable.

Aquafeed manufacturers have reduced, but not fully eliminated, fishmeal and fish oil and are seeking cost competitive replacements. We combined two commercially available microalgae, to produce a high-performing fish-free feed for Nile tilapia (Oreochromis niloticus)-the world's second largest group of farmed fish. We substituted protein-rich defatted biomass of Nannochloropsis oculata (leftover after oil extraction for nutraceuticals) for fishmeal and whole cells of docosahexaenoic acid (DHA)-rich Schizochytrium sp. as substitute for fish oil. We found significantly better (p < 0.05) growth, weight gain, specific growth rate, and best (but not significantly different) feed conversion ratio using the fish-free feed compared with the reference diet. Fish-free feed also yielded higher (p < 0.05) fillet lipid, DHA, and protein content (but not significantly different). Furthermore, fish-free feed had the highest degree of in-vitro protein hydrolysis and protein digestibility. The median economic conversion ratio of the fish-free feed ($0.95/kg tilapia) was less than the reference diet ($1.03/kg tilapia), though the median feed cost ($0.68/kg feed) was slightly greater than that of the reference feed ($0.64/kg feed) (p < 0.05). Our work is a step toward eliminating reliance on fishmeal and fish oil with evidence of a cost-competitive microalgae-based tilapia feed that improves growth metrics and the nutritional quality of farmed fish.

Dyslexia and Developmental Language Disorder: comorbid disorders with distinct effects on reading comprehension.

BACKGROUND: Reading comprehension draws on both decoding and linguistic comprehension, and poor reading comprehension can be the consequence of a deficit in either of these skills. METHODS: Using outcome data from the longitudinal Wellcome Language and Reading Project, we identified three groups of children at age 8 years: children with dyslexia (N = 21) who had deficits in decoding but not oral language, children with Developmental Language Disorder (DLD; N = 38) whose decoding skills were in the normal range, and children who met criteria for both dyslexia and DLD (N = 29). RESULTS: All three groups had reading comprehension difficulties at the ages of 8 and 9 years relative to TD controls though those of the children with dyslexia were mild (relative to TD controls, d = 0.51 at age 8, d = 0.60 at age 8); while the most severe problems were found in the comorbid dyslexia + DLD group (d = 1.79 at age 8, d = 2.06 at age 9) those with DLD also had significant difficulties (d = 1.56 at age 8, d = 1.56 at age 9). CONCLUSIONS: These findings confirm that children with dyslexia or DLD are at-risk for reading comprehension difficulties but for different reasons, because of weak decoding in the case of dyslexia or weak oral language skills in the case of DLD. Different forms of intervention are required for these groups of children, targeted to their particular area(s) of weakness.

Developmental Outcomes for Children at High Risk of Dyslexia and Children With Developmental Language Disorder.

We followed children at family risk of dyslexia and children with preschool language difficulties from age 3½, comparing them with controls (N = 234). At age 8, children were classified as having dyslexia or Developmental Language Disorder (DLD) and compared at earlier time points with controls. Children with dyslexia have specific difficulties with phonology and emergent reading skills in the preschool period, whereas children with DLD, with or without dyslexia, show a wider range of impairments including significant problems with executive and motor tasks. For children with both dyslexia and DLD, difficulties with phonology are generally more severe than those observed in children with dyslexia or DLD alone. Findings confirm that poor phonology is the major cognitive risk factor for dyslexia.

Longitudinal relationships between speech perception, phonological skills and reading in children at high-risk of dyslexia.

Speech perception deficits are commonly reported in dyslexia but longitudinal evidence that poor speech perception compromises learning to read is scant. We assessed the hypothesis that phonological skills, specifically phoneme awareness and RAN, mediate the relationship between speech perception and reading. We assessed longitudinal predictive relationships between categorical speech perception, phoneme awareness, RAN, language, attention and reading at ages 5½ and 6½ years in 237 children many of whom were at high risk of reading difficulties. Speech perception at 5½ years correlated with language, attention, phoneme awareness and RAN concurrently and was a predictor of reading at 6½ years. There was no significant indirect effect of speech perception on reading via phoneme awareness, suggesting that its effects are separable from those of phoneme awareness. Children classified with dyslexia at 8 years had poorer speech perception than age-controls at 5½ years and children with language disorders (with or without dyslexia) had more severe difficulties with both speech perception and attention control. Categorical speech perception tasks tap factors extraneous to perception, including decision-making skills. Further longitudinal studies are needed to unravel the complex relationships between categorical speech perception tasks and measures of reading and language and attention.

A systematic review of cognitive function and psychosocial well-being in school-age children with narcolepsy.

In August 2010, concerns were raised about an increase in the incidence rate of narcolepsy diagnosis in children and adolescents. Narcolepsy is a chronic neurological sleep disorder characterised by excessive daytime sleepiness and attacks of muscle weakness which are often precipitated by strong emotions, known as cataplexy. We systematically examined and updated the scientific literature on the consequences of narcolepsy on cognitive function and psychosocial well-being in school-age children. Eight studies published between 2005 and 2015 were eligible for inclusion in this review. Collectively the results provide evidence to suggest that children who develop narcolepsy are at significant risk of cognitive impairment in at least one domain and emotional problems including depression, anxiety and low self-esteem. Children with narcolepsy should be monitored carefully in order to manage and reduce the impact of any impairments present. The existing literature is limited by small sample sizes, lack of appropriate controls and lack of longitudinal data. Future research should aim to address the limitations of the current work and aim to determine the underlying cause of cognitive and psychological impairments. This will enable the design of effective interventions to support children with narcolepsy so that they are able to achieve their full potential.

Are the literacy difficulties that characterize developmental dyslexia associated with a failure to integrate letters and speech sounds?

The 'automatic letter-sound integration hypothesis' (Blomert, ) proposes that dyslexia results from a failure to fully integrate letters and speech sounds into automated audio-visual objects. We tested this hypothesis in a sample of English-speaking children with dyslexic difficulties (N = 13) and samples of chronological-age-matched (CA; N = 17) and reading-age-matched controls (RA; N = 17) aged 7-13 years. Each child took part in two priming experiments in which speech sounds were preceded by congruent visual letters (congruent condition) or Greek letters (baseline). In a behavioural experiment, responses to speech sounds in the two conditions were compared using reaction times. These data revealed faster reaction times in the congruent condition in all three groups. In a second electrophysiological experiment, responses to speech sounds in the two conditions were compared using event-related potentials (ERPs). These data revealed a significant effect of congruency on (1) the P1 ERP over left frontal electrodes in the CA group and over fronto-central electrodes in the dyslexic group and (2) the P2 ERP in the dyslexic and RA control groups. These findings suggest that our sample of English-speaking children with dyslexic difficulties demonstrate a degree of letter-sound integration that is appropriate for their reading level, which challenges the letter-sound integration hypothesis.

The development of executive function and language skills in the early school years.

BACKGROUND: The developmental relationships between executive functions (EF) and early language skills are unclear. This study explores the longitudinal relationships between children's early EF and language skills in a sample of children with a wide range of language abilities including children at risk of dyslexia. In addition, we investigated whether these skills independently predict children's attention/behaviour skills. METHOD: Data are presented from 243 children at four time points. Children were selected for being at risk of reading difficulties either because of a family history of dyslexia (FR; N = 90) or because of concerns regarding their language development (LI; N = 79) or as typically developing controls (TD; N = 74). The children completed tasks to assess their executive function and language skills at ages 4, 5 and 6 years. At 6 (T4) and 7 years (T5) parents and teachers rated the children's attention/behaviour skills. RESULTS: There was a strong concurrent relationship between language and EF at each assessment. Longitudinal analyses indicated a considerable degree of stability in children's language and EF skills: the influence of language on later EF skills (and vice versa) was weak and not significant in the current sample. Children's EF, but not language, skills at T3 predicted attention/behaviour ratings at T4/T5. CONCLUSIONS: There is a strong concurrent association between language and EF skills during the preschool and early school years, when children with language impairment show persistent EF deficits. Latent variables measuring language and EF show high longitudinal stability with little evidence of significant or strong reciprocal influences between these constructs. EF, but not language, skills predict later ratings of children's attention and behaviour.

Language profiles and literacy outcomes of children with resolving, emerging, or persisting language impairments.

BACKGROUND: Children with language impairment (LI) show heterogeneity in development. We tracked children from pre-school to middle childhood to characterize three developmental trajectories: resolving, persisting and emerging LI. METHODS: We analyzed data from children identified as having preschool LI, or being at family risk of dyslexia, together with typically developing controls at three time points: t1 (age 3;09), t3 (5;08) and t5 (8;01). Language measures are reported at t1, t3 and t5, and literacy abilities at t3 and t5. A research diagnosis of LI (irrespective of recruitment group) was validated at t1 by a composite language score derived from measures of receptive and expressive grammar and vocabulary; a score falling 1SD below the mean of the typical language group on comparable measures at t3 and t5 was used to determine whether a child had LI at later time points and then to classify LIs as resolving, persisting or emerging. RESULTS: Persisting preschool LIs were more severe and pervasive than resolving LIs. Language and literacy outcomes were relatively poor for those with persisting LI, and relatively good for those with resolving LI. A significant proportion of children with average language abilities in preschool had LIs that emerged in middle childhood - a high proportion of these children were at family risk of dyslexia. There were more boys in the persisting and resolving LI groups. Children with early LIs which resolved by the start of formal literacy instruction tended to have good literacy outcomes; children with late-emerging difficulties that persisted developed reading difficulties. CONCLUSIONS: Children with late-emerging LI are relatively common and are hard to detect in the preschool years. Our findings show that children whose LIs persist to the point of formal literacy instruction frequently experience reading difficulties.

The Foundations of Literacy Development in Children at Familial Risk of Dyslexia.

The development of reading skills is underpinned by oral language abilities: Phonological skills appear to have a causal influence on the development of early word-level literacy skills, and reading-comprehension ability depends, in addition to word-level literacy skills, on broader (semantic and syntactic) language skills. Here, we report a longitudinal study of children at familial risk of dyslexia, children with preschool language difficulties, and typically developing control children. Preschool measures of oral language predicted phoneme awareness and grapheme-phoneme knowledge just before school entry, which in turn predicted word-level literacy skills shortly after school entry. Reading comprehension at 8½ years was predicted by word-level literacy skills at 5½ years and by language skills at 3½ years. These patterns of predictive relationships were similar in both typically developing children and those at risk of literacy difficulties. Our findings underline the importance of oral language skills for the development of both word-level literacy and reading comprehension.

Developmental dyslexia: predicting individual risk.

BACKGROUND: Causal theories of dyslexia suggest that it is a heritable disorder, which is the outcome of multiple risk factors. However, whether early screening for dyslexia is viable is not yet known. METHODS: The study followed children at high risk of dyslexia from preschool through the early primary years assessing them from age 3 years and 6 months (T1) at approximately annual intervals on tasks tapping cognitive, language, and executive-motor skills. The children were recruited to three groups: children at family risk of dyslexia, children with concerns regarding speech, and language development at 3;06 years and controls considered to be typically developing. At 8 years, children were classified as 'dyslexic' or not. Logistic regression models were used to predict the individual risk of dyslexia and to investigate how risk factors accumulate to predict poor literacy outcomes. RESULTS: Family-risk status was a stronger predictor of dyslexia at 8 years than low language in preschool. Additional predictors in the preschool years include letter knowledge, phonological awareness, rapid automatized naming, and executive skills. At the time of school entry, language skills become significant predictors, and motor skills add a small but significant increase to the prediction probability. We present classification accuracy using different probability cutoffs for logistic regression models and ROC curves to highlight the accumulation of risk factors at the individual level. CONCLUSIONS: Dyslexia is the outcome of multiple risk factors and children with language difficulties at school entry are at high risk. Family history of dyslexia is a predictor of literacy outcome from the preschool years. However, screening does not reach an acceptable clinical level until close to school entry when letter knowledge, phonological awareness, and RAN, rather than family risk, together provide good sensitivity and specificity as a screening battery.

Am I dyslexic? Parental self-report of literacy difficulties.

In the absence of criteria for the diagnosis of dyslexia, considerable weight is given to self-report, in particular in studies of children at family risk of dyslexia. The present paper uses secondary data from a previous study to compare parents who self-report as dyslexic and those who do not, in relation to objectively determined levels of ability. In general, adults are more likely to self-report as 'dyslexic' if they have poorer reading and spelling skills and also if there is a discrepancy between IQ and measured literacy. However, parents of higher social status who have mild literacy difficulties are more likely to self-report as dyslexic than parents who have weaker literacy skills but are less socially advantaged. Together the findings suggest that the judgement as to whether or not a parent considers themselves 'dyslexic' is made relative to others in the same social sphere. Those who are socially disadvantaged may, in turn, be less likely to seek support for their children.

Learning to read new words in individuals with Down syndrome: testing the role of phonological knowledge.

This study examined the effect of word level phonological knowledge on learning to read new words in Down syndrome compared to typical development. Children were taught to read 12 nonwords, 6 of which were pre-trained on their phonology. The 16 individuals with Down syndrome aged 8-17 years were compared first to a group of 30 typically developing children aged 5-7 years matched for word reading and then to a subgroup of these children matched for decoding. There was a marginally significant effect for individuals with Down syndrome to benefit more from phonological pre-training than typically developing children matched for word reading but when compared to the decoding-matched subgroup, the two groups benefitted equally. We explain these findings in terms of partial decoding attempts being resolved by word level phonological knowledge and conclude that being familiar with the spoken form of a new word may help children when they attempt to read it. This may be particularly important for children with Down syndrome and other groups of children with weak decoding skills.

Comorbidities in preschool children at family risk of dyslexia.

BACKGROUND: Comorbidity among developmental disorders such as dyslexia, language impairment, attention deficit/hyperactivity disorder and developmental coordination disorder is common. This study explores comorbid weaknesses in preschool children at family risk of dyslexia with and without language impairment and considers the role that comorbidity plays in determining children's outcomes. METHOD: The preschool attention, executive function and motor skills of 112 children at family risk for dyslexia, 29 of whom also met criteria for language impairment, were assessed at ages 3½ and 4½ years. The performance of these children was compared to the performance of children with language impairment and typically developing controls. RESULTS: Weaknesses in attention, executive function and motor skills were associated with language impairment rather than family risk status. Individual differences in language and executive function are strongly related during the preschool period, and preschool motor skills predicted unique variance (4%) in early reading skills over and above children's language ability. CONCLUSION: Comorbidity between developmental disorders can be observed in the preschool years: children with language impairment have significant and persistent weaknesses in motor skills and executive function compared to those without language impairment. Children's early language and motor skills are predictors of children's later reading skills.

Preschool language profiles of children at family risk of dyslexia: continuities with specific language impairment.

BACKGROUND: Children at family risk of dyslexia have been reported to show phonological deficits as well as broader language delays in the preschool years. METHOD: The preschool language skills of 112 children at family risk of dyslexia (FR) at ages 3½ and 4½ were compared with those of children with SLI and typically developing (TD) controls. RESULTS: Children at FR showed two different profiles: one third of the group resembled the children with SLI and scored poorly across multiple domains of language including phonology. As a group, the remaining children had difficulties on tasks tapping phonological skills at T1 and T2. At the individual level, we confirmed that some FR children had both phonological and broader oral language difficulties (compared with TD controls), some had only phonological difficulties and some appeared to be developing typically. CONCLUSIONS: We have highlighted the early overlap between family risk of dyslexia and SLI. A family history of dyslexia carries an increased risk for SLI and the two disorders both show an increased incidence of phonological deficits which appear to a proximal risk factor for developing a reading impairment.

The growth of reading skills in children with Down Syndrome.

There appears to be a close and probably causal relationship between early variations in phoneme skills and later reading skills in typically developing children, though the pattern in children with Down Syndrome is less clear. We present the results of a 2-year longitudinal study of 49 children with Down Syndrome (DS) and 61 typically developing (TD) control children with similar initial levels of reading skill. Phoneme awareness and vocabulary were strong concurrent predictors of initial levels of reading skill in both groups. However, longitudinally phoneme awareness was a predictor of the growth of reading skills in TD children but not in children with DS. There was a very high degree of longitudinal stability in reading skills in children with DS, and initial levels of reading skills seemed to be highly constrained by general language skills, as indexed by vocabulary knowledge, in this population. We conclude that reading development in children with DS shows similarities and differences to the pattern observed in TD children and that phoneme awareness appears to be a less powerful influence on the development of reading skills in children with DS.

Semantic and phonological fluency in children with Down syndrome: atypical organization of language or less efficient retrieval strategies?

In this study the verbal fluency procedure was used to investigate the organization of semantic and phonological representations in children with Down syndrome (DS) and typically developing children, matched pairwise for receptive vocabulary age. Productivity was found to be significantly reduced in the DS group in both the semantic and the phonological tasks. However, group differences in the number of clusters as opposed to cluster size suggest that this may reflect less efficient retrieval strategies rather than differences in the organization of linguistic representations. Together the findings point to executive deficits in Down syndrome rather than deviant language processes.