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Neural basis of dyslexia: a comparison between dyslexic and nondyslexic children equated for reading ability.

Adults and children with developmental dyslexia exhibit reduced parietotemporal activation in functional neuroimaging studies of phonological processing. These studies used age-matched and/or intelligence quotient-matched control groups whose reading ability and scanner task performance were often superior to that of the dyslexic group. It is unknown, therefore, whether differences in activation reflect simply poorer performance in the scanner, the underlying level of reading ability, or more specific neural correlates of dyslexia. To resolve this uncertainty, we conducted a functional magnetic resonance imaging study, with a rhyme judgment task, in which we compared dyslexic children with two control groups: age-matched children and reading-matched children (younger normal readers equated for reading ability or scanner-performance to the dyslexic children). Dyslexic children exhibited reduced activation relative to both age-matched and reading-matched children in the left parietotemporal cortex and five other regions, including the right parietotemporal cortex. The dyslexic children also exhibited reduced activation bilaterally in the parietotemporal cortex when compared with children equated for task performance during scanning. Nine of the 10 dyslexic children exhibited reduced left parietotemporal activation compared with their individually selected age-matched or reading-matched control children. Additionally, normal reading fifth graders showed more activation in the same bilateral parietotemporal regions than normal-reading third graders. These findings indicate that the activation differences seen in the dyslexic children cannot be accounted for by either current reading level or scanner task performance, but instead represent a distinct developmental atypicality in the neural systems that support learning to read.

Brain Mapping↗

Patterns of cerebral activation during lexical and phonological reading in Portuguese.

According to the concepts of cognitive neuropsychology, there are two principal routes of reading processing: a lexical route, in which global reading of words occurs and a phonological route, responsible for the conversion of the graphemes into their respective phonemes. In the present study, functional magnetic resonance imaging (fMRI) was used to investigate the patterns of cerebral activation in lexical and phonological reading by 13 healthy women with a formal educational level greater than 11 years. Participants were submitted to a silent reading task containing three types of stimuli: real words (irregular and foreign words), nonwords and illegitimate graphic stimuli. An increased number of activated voxels were identified by fMRI in the word reading (lexical processing) than in the nonword reading (phonological processing) task. In word reading, activation was greater than for nonwords in the following areas: superior, middle and inferior frontal gyri, and bilateral superior temporal gyrus, right cerebellum and the left precentral gyrus, as indicated by fMRI. In the reading of nonwords, the activation was predominant in the right cerebellum and in the left superior temporal gyrus. The results of the present study suggest the existence of differences in the patterns of cerebral activation during lexical and phonological reading, with greater involvement of the right hemisphere in reading words than nonwords.

Adolescent↗

Encouraging science reading beyond the curriculum.

Students in genetics and reproductive physiology, junior-/senior-level courses with enrollments averaging 76 and 41 students, respectively, were encouraged to read popular science books for extra credit. The objectives of the readings were to reinforce basic class concepts by forming ties to everyday life, and to expose students to a genre that can provide information to prepare them as citizens to engage in the debate over current issues. The books for genetics were The Double Helix, Genome, Voyage of the Beagle, and The Engineer in the Garden; and the books for reproductive physiology were Clone, Lives of a Cell, Life Before Birth and A Time to be Born, and The Second Creation: Dolly and The Age of Biological Control. To earn credit (3% of the course grade for each of up to three books), students had to demonstrate knowledge and understanding of each book during a 15-min discussion with the instructor. Discussions focused on questions designed to stimulate critical thinking about each book's content. For example: "There is approximately 98% homology in DNA sequence between humans and chimpanzees; in aspects ranging from basic physiology to behavior, what makes us similar to or different from the species that is our closest living relative?" The numbers of students reading three books in Years 1 and 2 were 2 and 12 in genetics, and 4 and 3 in reproductive physiology; those reading two books in Years 1 and 2 were 5 and 20 in genetics, and 0 and 2 in reproductive physiology; and those reading one book in Years 1 and 2 were 21 and 31 in genetics, and 7 and 8 in reproductive physiology. The numbers of students that read no books in Years 1 and 2 were 33 and 27 in genetics, and 45 and 20 in reproductive physiology. Participation in the reading project occurred independently of course grades. Sixteen genetics students from the second year's class, eight that had participated in the extra credit reading and eight that had not, volunteered to be reexamined on material from the class. The reexamination was conducted 3 mo after the end of the class. With first exam score fitted as a covariate (P < 0.10), participation in the extra credit reading assignment did not affect score on the reexamination; participants averaged 67% correct answers, nonparticipants averaged 59% (P = 0.37). Comments on course evaluations indicated broad satisfaction with the assignments. Although no improvement of retention could be documented from this project, our objective of encouraging students to engage in reading material supplemental to courses in genetics and reproductive physiology was satisfied.

Curriculum↗

Reading habits of house-staff: what, where and why.

As in-training evaluations often comment that house-staff do not read enough about cases, this study looked at the reading habits of internal medicine students and house-staff to assess whether they were reading about cases. All 38 trainees at a major teaching hospital were surveyed with a questionnaire. Overall, the house-staff read 8.7 hours/week, of which half is spent reading about cases. They read around approximately half of the cases they see. The more senior house-staff use journals and one major textbook; the medical students use only textbooks. The reading is done mainly at home, except by the senior residents who spent a quarter of their reading time in the library. The major reasons why the house-staff read are to prepare for presentations or for rounds with the attending physicians. These results suggest that contrary to what we anticipated, house-staff do indeed read about the cases they see on the wards.

Education, Medical, Continuing↗

Development of a reading speed test for potential-vision measurements.

PURPOSE: Previous studies suggest that optimal reading speed is unaffected by cataract, yet is significantly reduced in age-related macular degeneration (ARMD ). This raises the question of whether a reading speed test could be developed to assess potential vision after cataract surgery. METHODS: Nineteen subjects with cataract, 15 with ARMD, and 13 control subjects with normal, healthy eyes read Bailey-Lovie word charts aloud, and subsequently, critical print size and optimal reading speed were calculated. Measurements were also taken with the charts in reversed-contrast polarity and after pupillary dilation. RESULTS: Although the subjects with cataract had reduced word acuity and increased critical print size, optimal reading speed was similar to that of the control group at a mean of approximately 100 wpm. Optimal reading speed in the subjects with ARMD was substantially worse (mean of 39 wpm). Reversing the contrast polarity of the charts slightly increased the word acuity and optimal reading speed of the subjects with cataract. CONCLUSIONS: The results suggest that optimal reading speed would be useful as a potential-vision test. The proposed test would use text size of at least 1.32 degrees (1.2 log minimum angle of resolution [logMAR]), and pupil dilation would be unnecessary. A reading test with black letters on a white background would be adequate, because charts with reversed-contrast polarity made minimal difference in reading speed.

Aged↗

[Fixation points and retinal sensitivity observed in reading text by patients with bilateral macular atrophy].

PURPOSE: To study by use of a scanning laser ophthalmoscope(SLO). How patients with bilateral macular atrophy use their retinas in reading Japanese sentences of varying sizes. METHODS: Thirty-eight eyes of 19 patients with bilateral macular atrophy were examined. Sentences of a fixed length (MNREAD-J sentences) were projected onto the patients' retinas with the SLO, and the size of the letters was varied. Patients were asked to read aloud the sentences slowly, and both their voices and retinal images were recorded simultaneously on videotape so that we could locate the retinal area they were using for reading. We compared these fixation points in reading with simple fixation points obtained by SLO microperimetry. RESULTS: In 21 eyes, the patients used the same area of the retina in all measurements. In 15 eyes, the fixation points for reading differed from the fixation area measured by microperimetry. In 8 of the 15 eyes, the fixation area for reading changed as the letter size was altered. In 2 eyes, oral reading was impossible, and no fixation point was established. CONCLUSIONS: The combination of SLO with reading evaluation clarified the fixation area for oral reading. Multiple fixation points were thought to be present quite commonly in eyes with macular degeneration. The fixation point was thought to be determined by the macular condition and the size of the letters being read.

Adult↗

[Reading performance in patients with central visual field disturbance due to glaucoma].

PURPOSE: To evaluate the relationship between central visual field disturbance due to glaucoma and reading performance. SUBJECTS AND METHODS: We evaluated the reading performance of 11 patients (14 eyes) with visual acuities of 1.0 and higher who had absolute scotoma within 3 degrees of the central visual field. The ages of the patients ranged from 37 to 77, with a median of 62 years. Maximum reading speed of texts printed horizontally and vertically was measured using MNREAD-J. Subjective reading difficulties were investigated orally. The relationship between the maximum reading speed of both horizontal and vertical texts, the subjective reading difficulties, the number of quadrants, and the position and continuity of absolute scotoma were evaluated. RESULTS: The mean maximum reading speed for vertical and horizontal texts by the 11 patients was 323 and 335 characters/minute(c/m), respectively, and was not significantly slower than that of normal eyes. In 2 of 14 eyes, a significant (p < 0.05) difference between maximum vertical and horizontal reading speeds was observed. In 3 of 14 eyes, absolute scotoma was distributed continuously in more than 2 adjacent quadrants, and these patients also had subjective reading difficulties. CONCLUSION: Reading difficulty is present in patients having absolute scotoma within 3 degrees of the central visual field when the scotoma involves more than 2 adjacent quadrants.

Adult↗

[Reading habits of Norwegian physicians].

Norwegian doctors spend on average 3.4 hours per week reading medical literature. 2/3 of this time is spent on medical journals. These are the main findings in a survey of self-reported reading time among 760 Norwegian doctors. Hospital doctors read more than doctors working outside hospital (3.9 vs. 2.7 hours per week), and internists spend more time reading than surgeons and general practitioners do. All categories of doctors report spending approximately one hour per week reading other material than journals and articles, and the differences between groups as regards reading time are accounted for by differences in the time spent on medical journals. Nine out of ten doctors read Tidsskrift for Den norske laegeforening (the Journal of the Norwegian Medical Association) regularly, and 2/3 read Nordisk Medicine (the Nordic Medical Journal). Every fifth doctor reads at least one out of four specified international journals (British Medical Journal, Lancet, New England Journal of Medicine or JAMA). Only one out of fifteen Norwegian doctors reads Läkartidningen (the Swedish Medical Journal) and Ugeskrift for Laeger (the Danish Medical Journal) on a regular basis.

Humans↗

Motivational and Cognitive Contributions to Students' Amount of Reading.

The amount that students read for enjoyment and for school is a major contributor to students' reading achievement and knowledge of the world. Consequently, it is important to identify the factors that predict amount of reading. A literature review revealed that motivation, strategy-use, and past reading achievement all may be expected to predict reading amount. To examine these variables, a total of 251 students in Grades 3 and 5 was administered questionnaires of these constructs and a reading test. Results showed that amount of reading for enjoyment was predicted most highly by motivation, when all other variables were controlled statistically in multiple-regression analyses. In contrast, amount of reading for school was predicted most highly by strategy use, when all other variables were controlled. However, these predictions were different for students in Grades 3 and 5. Findings of the study indicate that amount of reading is multiply determined by cognitive and motivational constructs, which is consistent with an engagement perspective on reading development. Copyright 2001 Academic Press.

Journal Article↗

Varieties of developmental reading disorder: genetic and environmental influences.

There is widespread support for the notion that subgroups of dyslexics can be identified who differ in their reading profiles: Developmental phonological dyslexia is characterized by poor nonword reading, while developmental surface dyslexia is distinguished by a particular difficulty in reading irregular words. However, there is much less agreement about how these subtypes, and particularly the surface dyslexic pattern, are to be accounted for within theoretical models of the reading system. To assist in addressing this issue, the heritability of reading deficits in dyslexic subtypes was examined using a twin sample. Subjects' scores on (a) an exception word reading task and (b) a nonword reading task were used to create a subtype dimension, and surface and phonological dyslexic subgroups were selected from the ends of this distribution. Reading deficits were found to be significantly heritable in both subgroups. However, the genetic contribution to the group reading deficit was much greater in the phonological dyslexics than in the surface dyslexics. The finding of differential genetic etiology across subtypes suggests that there is at least partial independence in the development of the cognitive processes involved in reading exception words and nonwords. Also, the results support accounts of surface dyslexia which emphasize a strong environmental contribution.

Adolescent↗

Specific reading and phonological processing deficits are associated with damage to the left frontal operculum.

Functional neuroimaging studies in normal subjects indicate that a region in the left frontal operculum (FO) is more active when subjects read pronounceable nonwords as compared to most word types. Here, we report convergent evidence on this finding using the lesion method. We tested the prediction that subjects with left FO damage would have impaired reading of pronounceable nonwords, but relatively intact reading of most word types. Eleven target subjects with circumscribed left FO lesions, and two comparison groups of either brain-damaged or normal subjects matched to the target subjects for age, sex, handedness, and education, were studied using reading tasks derived from previous neuroimaging work. As predicted, the FO group was significantly less accurate than the comparison groups at reading nonwords. By contrast, the FO subjects showed relatively intact word reading, a pattern consistent with the syndrome of "phonological dyslexia". The FO subjects, however, did exhibit particular difficulty reading low frequency words with inconsistent grapheme-to-phoneme correspondences (e.g., PINT), which parallels the finding from functional imaging studies that reading such items produces more activation in left FO than reading high frequency words and low frequency words with consistent grapheme-to-phoneme correspondences (e.g., JADE) (Fiez et al., 1999). In several follow-up experiments, we found that the FO subjects were also impaired on other phonological tasks that have been associated with left frontal opercular activation in functional neuroimaging studies. The findings converge nicely with extant functional imaging work, and provide further evidence that regions within the left FO are part of a system that makes specific and critical contributions to some of the phonological processes that support reading.

Adult↗

Specific reading disability (dyslexia): what have we learned in the past four decades?

We summarize some of the most important findings from research evaluating the hypothesized causes of specific reading disability ('dyslexia') over the past four decades. After outlining components of reading ability, we discuss manifest causes of reading difficulties, in terms of deficiencies in component reading skills that might lead to such difficulties. The evidence suggests that inadequate facility in word identification due, in most cases, to more basic deficits in alphabetic coding is the basic cause of difficulties in learning to read. We next discuss hypothesized deficiencies in reading-related cognitive abilities as underlying causes of deficiencies in component reading skills. The evidence in these areas suggests that, in most cases, phonological skills deficiencies associated with phonological coding deficits are the probable causes of the disorder rather than visual, semantic, or syntactic deficits, although reading difficulties in some children may be associated with general language deficits. Hypothesized deficits in general learning abilities (e.g., attention, association learning, cross-modal transfer etc.) and low-level sensory deficits have weak validity as causal factors in specific reading disability. These inferences are, by and large, supported by research evaluating the biological foundations of dyslexia. Finally, evidence is presented in support of the idea that many poor readers are impaired because of inadequate instruction or other experiential factors. This does not mean that biological factors are not relevant, because the brain and environment interact to produce the neural networks that support reading acquisition. We conclude with a discussion of the clinical implications of the research findings, focusing on the need for enhanced instruction.

Brain↗

Follow-up and final results of the Oslo I Study comparing screen-film mammography and full-field digital mammography with soft-copy reading.

PURPOSE: To compare cancer detection rates of screen-film (SFM) and full-field digital mammography (FFDM) with soft-copy reading in a screening program including the initial positive scores for interval cancers and cancers in the subsequent screening round, and to analyze the false-negative FFDM interpretations. MATERIAL AND METHODS: Using a paired study design, 3683 women underwent SFM and FFDM in a population-based screening program. Two standard views of each breast were acquired. The images were interpreted without previous films for comparison. Independent double reading using a 5-point rating scale for probability of cancer was used for each modality. An examination was defined as positive if at least one of the two independent readers scored 2 or higher on the 5-point rating scale. SFM-positive cases were discussed in a SFM consensus meeting and FFDM-positive cases in a separate FFDM consensus meeting before recall. The study population was followed for more than 2 years so that interval cancers and screen-detected cancers in the subsequent screening round could be included. Cancer detection rates were compared using the McNemar test for paired proportions. The kappa statistic and Wilcoxon signed-rank test for matched pairs were used for comparing rating scores. The reading time was recorded for all FFDM interpretations. RESULTS: A total of 31 cancers (detection rate 0.84%) were diagnosed initially, of which SFM detected 28 and FFDM 23 (McNemar test P=0.23, discordant pair 8 and 3). Two cancers with a positive score at initial SFM reading and three with a positive score at initial FFDM reading were dismissed at SFM and FFDM consensus meetings, respectively. The difference in cancer detection after recall (discordant pair 11 and 5) was not significant (McNemar test, P=0.21). Of the 10 interval cancers and 16 screen-detected cancers in the subsequent round, 3 had true-positive SFM scores while 4 had true-positive FFDM scores in the initial reading session. A total of 38 cancers therefore had a positive result at double reading at one or both modalities, 31 at SFM and 27 at FFDM (McNemar test, P=0.48). Comparison of SFM and FFDM interpretations using the mean score for each case revealed no statistically significant difference between the two modalities (Wilcoxon signed-rank test for matched pairs; P-value=0.228). Two initial round cancers (one tumor found incidentally at work-up for a mass proved to be a simple cyst with a positive score at FFDM but a negative score at SFM, and one tumor with positive score at SFM but negative score at FFDM due to positioning failure) were excluded from the further analysis. Excluding these two cancers from comparison, there were 31% (22 of 72) false-negative SFM and 47% (34 of 72) false-negative FFDM individual interpretations. The overall mean interpretation time for normal FFDM examinations was 45 s. For most false-negative FFDM results, the reading time was shorter or longer than for normal examinations. The recorded FFDM interpretation time was noticeably short for several overlooked cancers manifesting as microcalcifications (ductal carcinoma in situ). CONCLUSION: There is no statistically significant difference in cancer detection rate between SFM and FFDM with soft-copy reading in a mammography screening program. Analysis of cancers missed at FFDM with soft-copy reading indicates that close attention has to be paid to systematic use of image display protocols.

Aged↗

Comparability of ophthalmic diagnoses by clinical and Reading Center examiners in the Visual Acuity Impairment Survey Pilot Study.

Technologic advances in ophthalmic equipment offer the possibility of replacing direct clinical examinations with Reading Center evaluations of data recorded in epidemiologic studies. Clinical and Reading Center examiners made independent ophthalmic diagnoses of 133 right and 132 left eyes of 138 adults in the Visual Acuity Impairment Survey Pilot Study, carried out in three US cities, Boston, Detroit, and Minneapolis, in August 1981-December 1982. The Reading Center diagnosed eye conditions using only photographic and visual field data collected at the time of the clinical examination. In the comparisons of clinical and Reading Center evaluations reported here, only eyes judged by the examiners to have pathology severe enough to reduce visual acuity to 6/9 or worse were classified as having pathology. (No visual acuity criterion was required for the diagnosis of glaucoma or diabetic retinopathy.) There was agreement in diagnostic assessments between clinical and Reading Center examiners in about 80% of eyes. The kappa statistic, which adjusts for chance agreement, was in the fair to good range: 0.60 for 133 right eyes and 0.62 for 132 left eyes. When the Reading Center examiners were provided with additional information on medical history, refractive error and best corrected visual acuity, the agreement between clinical and Reading Center assessments among the subset of eyes with 6/9 or worse vision again was in the fair to good range, with kappas of 0.61 for 45 right eyes and 0.68 for 48 left eyes. Inter-observer agreement between Reading Center examiners in diagnosing pathology was in the good to excellent range. Use of Reading Centers in future epidemiologic studies should be considered, but elimination of the clinical examinations is not recommended until modifications in the protocol described here have been made and shown to improve levels of agreement between clinical and Reading Center examiners.

Eye Diseases↗

Illumination and reading performance in age-related macular degeneration.

BACKGROUND: Previous studies have compared low vision reading performance at optimal task illuminance and consulting room illuminance (500 to 600 lux). However, it is uncertain the extent to which low vision reading performance can be improved when task illumination is increased from levels more representative of those found in the typical living room (50 lux) to levels likely to maximise performance. METHODS: Reading performance of 20 subjects with age-related macular degeneration (AMD) was assessed for a range of print sizes using sentence reading charts at six levels of task illuminance (50 to 5,000 lux). Subjects read without low vision devices. RESULTS: Sentence reading acuity and critical print size improved by a factor of two over the 50 to 5,000 lux range, while maximum reading rate improved by a factor of 1.4. For the majority of subjects (70 per cent), the optimal task illuminance (determined objectively) was higher (median 3,500 lux) than the subjectively preferred task illuminance (median 2,450 lux). Reading performance was significantly better at the optimal illuminance than at illuminances equivalent to those found in the domestic environment (50 lux) or consulting room (600 lux). CONCLUSIONS: The majority of AMD patients will require task illumination of at least 2,000 lux to maximise reading performance. Optimal illumination should be determined individually for each patient using both objective measures of performance, such as reading acuity, and subjective assessments of visual comfort.

Journal Article↗

Role of visual attention in cognitive control of oculomotor readiness in students with reading disabilities.

This study investigated eye movement and comprehension therapy in Grade 6 children with reading disabilities (RD). Both order of therapy and type of therapy were examined. Furthermore, the implications of visual attention in ameliorating reading disability are discussed. Thirty-one students with RD were identified using standardized reading comprehension tests. Eye movements were analyzed objectively using an infra-red recording device. Reading scores of participating children were 0.5 to 1 SD below the national mean. Testing took place before the start of therapy (T1) and was repeated after 12 weeks (T2) and 24 weeks (T3) of therapy. One group of students had eye movement therapy first, followed by comprehension therapy; in the other group, the order was reversed. Data were evaluated using a repeated measures MANOVA and post hoc tests. At T1, mean reading grade was 2 years below grade level, and eye movement scores were at about Grade 2 level. Mean growth in reading comprehension for the total sample was 2.6 years (p < .01) at T3; equally significant improvement was measured in eye movements (p < .01). Learning rate in reading comprehension improved from 60% (T1) to 400% (T3). Although within-group differences were statistically significant, between-group differences were not significant for comprehension or eye movements. Order of therapy (comprehension first or eye movements first) was not significant. Improvements in within-group scores for comprehension and eye movements were consistently significant at T2 and T3. Eye movement therapy improved eye movements and also resulted in significant gains in reading comprehension. Comprehension therapy likewise produced improvement both in eye movement efficiency and in reading comprehension. The results support the notion of a cognitive link among visual attention, oculomotor readiness, and reading comprehension.

Attention↗

Can reading disabilities be diagnosed without using intelligence tests?

Unlike conventional procedures, which use IQ in making diagnostic and eligibility decisions regarding learning disabilities, this demonstration study used listening comprehension and other reading-related tasks to make a differential diagnosis of reading disabilities. Tests of listening and reading comprehension were administered to 180 children from Grades 3 through 8. A regression equation was then derived to predict reading comprehension from listening comprehension. The regression equation was applied to the listening comprehension scores of seven children from Grades 3 to 8 who had reading difficulties, and their reading comprehension was predicted. Based on the discrepancy between their actual reading comprehension and the predicted reading comprehension, their reading difficulty was attributed to one of the following three factors: (a) poor decoding, (b) poor comprehension, or (c) a combination of poor decoding and poor comprehension. The validity of these diagnostic decisions was assessed by testing independently these children's word-decoding skill and reading speed. The results suggest that this diagnostic procedure has potential utility.

Adolescent↗

The use of batch reading to improve the performance of screening mammography.

OBJECTIVE: The objective of our study was to prove that batch reading of screening mammograms can reduce recall rates without sacrificing cancer detection. MATERIALS AND METHODS: We analyzed recall rate, cancer detection, minimal cancer detection, detection of low-stage cancer, and tumor size from consecutive screening mammography examinations from October 2001 to July 2003. The initial 7,984 mammograms were interpreted in the midst of a busy breast imaging practice. Although these studies were not read online, the interpretations were often interrupted for telephone calls, procedures, and diagnostic mammograms. The remaining 1,538 studies were interpreted after the institution of dedicated uninterrupted batch reading. RESULTS: Recall rates were 20.1% before and 16.2% after the introduction of batch reading (p < 0.001). Cancer detection rates were not significantly different: 5.6 cancers were detected per 1,000 examinations without and 7.2 were detected per 1,000 with batch reading. Prognostic factors for breast cancers diagnosed between these groups also were not significantly different. Of the screening-detected cancers diagnosed before batch reading, minimal cancers comprised 67% and low-stage cancers accounted for 76%. Of the cancers diagnosed using batch reading, 73% were minimal and 91% were low stage. The mean size of cancers, 11.7 mm without batch reading and 9.1 mm with batch reading, also showed no statistically significant difference. CONCLUSION: Our experience shows that batch reading can significantly reduce screening mammography recall rates without affecting the cancer detection rate or the proportion of cancers diagnosed with favorable prognostic indicators.

Breast Neoplasms↗