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Reading problems, psychiatric disorders, and functional impairment from mid- to late adolescence.

OBJECTIVE: To examine psychiatric morbidity and functional impairment of adolescents with and without poor reading skills during mid- to late adolescence. METHOD: The sample consisted of 188 adolescents, 94 with poor reading skills and 94 with typical reading skills, screened from a larger sample in the public schools at age 15. To assess psychiatric disorders, participants were assessed annually with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version (up to 4.5 years; maximum age, 20 years). Functional impairment was assessed with the Child and Adolescent Functional Assessment Scale. RESULTS: Adolescents with poor reading skills evidenced higher rates of current attention-deficit/hyperactivity, affective, and anxiety disorders, particularly social phobia and generalized anxiety disorder. Anxiety disorders but not affective disorders were related to reading status after controlling for attention-deficit/hyperactivity disorder. Adolescents with poor reading evidenced more functional impairment across multiple areas than youths with typical reading skills, even after considering the presence of comorbid attention-deficit/hyperactivity disorder. CONCLUSIONS: The increased psychiatric morbidity and functional impairment of adolescents with reading problems highlight the importance of developing interventions that help these youths address reading deficits and associated vulnerabilities during the last years of secondary school.

Adolescent↗

Early reading difficulties and later conduct problems.

The relationships between early reading difficulties and later conduct problems were examined in a birth cohort of New Zealand children studied from the point of school entry to the age of 16. Children with early reading difficulties had increased rates of conduct problems up to the age of 16 years. These associations depended on context, being more evident for boys and tending to reduce with increasing age. However, the associations between early reading difficulties and later conduct problems were explained by the fact that children with early reading difficulties tended to be characterised by a number of disadvantageous features (and notably early-onset conduct problems) that were present before the onset of reading difficulties. When the associations between reading difficulties and conduct problems were adjusted for confounding factors there were no statistically significant associations between reading difficulties and conduct problems. These results were found to hold for various age and gender subgroups of the sample, for measures of reading difficulties defined in different ways, and for a wide range of outcome variables. It is concluded that, when due allowance is made for potentially confounding factors (and notably early conduct problems) and for factors correlated with these problems, it is unlikely that reading difficulties in early childhood are related to later conduct problems.

Adolescent↗

Agreement between visual and automated UniScept API readings.

The UniScept API system was evaluated for agreement of visual versus automated readings of both its identification panels and its antimicrobial susceptibility panels. The biochemical responses of 340 oxidase-negative and oxidase-positive fermentative bacterial cultures were read both visually and automatically in the UniScept API 20E system. Automated and visual readings agreed with 99.3% of the biochemicals. Of the 45 tests that disagreed, the tests for indole and citrate were most often in disagreement. A total of 470 fermentative and nonfermentative cultures were used in the UniScept MIC system to compare visual and automated readings of susceptibility results with 17 antimicrobial agents. Agreement within +/- 1 dilution occurred with 94.1% of the enteric fermenters and with 91.7% of the other cultures. Comparison of visual and automated readings resulted in very major discrepancies in 0.95% of the readings, with the largest percentage of discrepancies associated with glucose nonfermenters (1.8%). It was felt that an automated reading is an acceptable alternative to a visual reading of the biochemicals but that 0.95% was just within the acceptable range of the 1% allowable very major discrepancies in the automated reading of susceptibilities.

Bacteria↗

Scoring of radiographic progression in randomised clinical trials in ankylosing spondylitis: a preference for paired reading order.

OBJECTIVES: To describe the influence of the reading order (chronological v paired) on radiographic scoring results in ankylosing spondylitis. To investigate whether this method is sufficiently sensitive to change because paired reading is requested for establishing drug efficacy in clinical trials. METHODS: Films obtained from 166 patients (at baseline, 1 year, and 2 years) were scored by one observer, using the modified Stoke Ankylosing Spondylitis Spinal Score. Films were first scored chronologically, and were scored paired 6 months later. RESULTS: Chronological reading showed significantly more progression than paired reading both at 1 year (mean (SD) progression 1.3 (2.6) v 0.5 (2.4) units) and at 2 years (2.1 (3.9) v 1.0 (2.9) units); between-method difference: p<0.001 at 1 year, and p<0.001 at 2 years. After 1 year, progression (>0 units) was found in 35/166 (21%) patients after paired reading and in 55/166 (33%) after chronological reading. After 2 years, these figures were 50/166 (30%) and 68/166 (41%), respectively. Sample size calculations showed that 94 patients in each treatment arm are required in a randomised clinical trial (RCT) to provide sufficient statistical power to detect a difference in 2 year progression if films are scored paired. CONCLUSION: Reading with chronological time order is more sensitive to change than reading with paired time order, but paired reading is sufficiently sensitive to pick up change with a follow up of 2 years, resulting in an acceptable sample size for RCTs.

Adult↗

Effect of attention therapy on reading comprehension.

This study quantified the influence of visual attention therapy on the reading comprehension of Grade 6 children with moderate reading disabilities (RD) in the absence of specific reading remediation. Thirty students with below-average reading scores were identified using standardized reading comprehension tests. Fifteen children were placed randomly in the experimental group and 15 in the control group. The Attention Battery of the Cognitive Assessment System was administered to all participants. The experimental group received 12 one-hour sessions of individually monitored, computer-based attention therapy programs; the control group received no therapy during their 12-week period. Each group was retested on attention and reading comprehension measures. In order to stimulate selective and sustained visual attention, the vision therapy stressed various aspects of arousal, activation, and vigilance. At the completion of attention therapy, the mean standard attention and reading comprehension scores of the experimental group had improved significantly. The control group, however, showed no significant improvement in reading comprehension scores after 12 weeks. Although uncertainties still exist, this investigation supports the notion that visual attention is malleable and that attention therapy has a significant effect on reading comprehension in this often neglected population.

Attention↗

Formulating secondary-level reading interventions.

Recent advances concerning emerging/beginning reading skills, positive behavioral support (PBS), and three-tiered schoolwide prevention models combined with federal mandates (i.e., IDEA and No Child Left Behind) have stimulated interest in providing early and intensive instructional intervention services to children at risk for reading and behavior problems. New measures for identifying students as early as kindergarten who are not acquiring early basic literacy skills make this possible. However, questions regarding exactly how to formulate, deliver, sustain, and manage secondary-level interventions remain to be addressed. This paper describes first-year, first-grade findings for students participating in secondary-level interventions (i.e., small-group reading instruction) in a randomized trial of the efficacy of secondary and tertiary reading and behavior interventions under way at the Center for Early Intervention in Reading and Behavior, University of Kansas. The formulation of the experimental secondary-level intervention was guided by evidence supporting the efficacy of (a) small groups of 3 to 6 participating students and low student-teacher ratio combined with (b) explicit, phonics-based instruction. Selected curricula were Reading Mastery, Proactive Reading, Programmed Reading, and Read Well, use of which varied by choice across experimental-group schools. PBS was an additional intervention context in experimental schools. Comparison schools and first-grade teachers did not employ the three-tiered model, early screening, or PBS; most students were taught using conventional whole-group instruction, little or no individualization, and curricula with weak scientific evidence. Initial results indicate significantly larger growth for experimental secondary-level at-risk students than for comparisons. Experimental-group first graders not showing growth were those identified with disabilities or behavioral risks and English language learners. Implications are discussed.

Child↗

Independent double reading of screening mammograms.

OBJECTIVE: To evaluate the cost effectiveness of independent double reading of screening mammograms. SETTING: Prospective study of 18,817 women undergoing first or repeat screening in a population based programme in the Florence district. METHODS: Mammograms were independently double read by experienced radiologists. Subjects with mammographic abnormalities reported by at least one reader were recalled for diagnostic assessment. The mean increase in recall rate, cancer detection rate, and screening costs attributable to double reading was calculated. RESULTS: Eleven of 125 cancers were detected by only one reader. The mean increase in cancer detection rate attributable to double reading compared with single reading was 4.6% (95% confidence interval (CI) 1.1 to 8.9). From a total of 748 cases referred for diagnostic assessment, 196 subjects were referred by one reader only. The mean increase in referral rate attributable to double reading compared with single reading was 15.1% (CI 12.3 to 17.8). Double reading caused a marked increase in the cost for each woman screened -8.5% at the first screening and 6.2% at repeat screening and a more limited increase in the cost for each cancer detected -3.5% at the first screening and 2.7% at repeat screening. Cancers detected by only one screener were at an earlier stage than those detected by both screeners (P = 0.6, not significant). CONCLUSIONS: Independent double reading results in only a modest increase in the detection of cancers and therefore may not be cost effective.

Aged↗

On the performance and reliability of mechanized urine teststrip measurement in comparison with visual reading.

Prescreening of urine specimens by teststrips is a valuable procedure for reducing the work load of the urine analysis laboratory: positive results for leukocytes, erythrocytes (haemoglobin), protein, and/or nitrite are widely used to select pathological specimens for subsequent microscopic examination. By standardization of the measurement conditions, mechanized teststrip reading is claimed to give more reproducible results than conventional techniques. To assess their ability to improve urine prescreening, especially with regard to the comparability of the results, the practical and analytical performance of three commercially available analysers (Rapimat II/T from Behringwerke AG, Urotron RL9 from Boehringer Mannheim GmbH, and Clinitek 200 from Ames/Bayer Diagnostic) was compared with visual reading. Analytical criteria were assessed using routine urine samples, while reproducibility was tested by repeated analysis of three different commercial control urines (Kova Trol from Madaus). A mean imprecision between 3% and 11.9% was found for the mechanized dipstick reading which was comparable to that found with visual examination (4.5% with Combur9-teststrips, Boehringer Mannheim GmbH). Due to the crude classification of the results, the different analysers as well as the visual technique gave quite different distributions for each of the semiquantitative parameters in the same urine samples. Even if statistical analysis was restricted to the frequency of positive results only, significant differences (chi 2-test, p less than 0.001-0.05) between methods were obtained, but these differences could not be attributed to one method alone. Using microscopic sediment analysis as reference, pathological urines were detected with a comparable sensitivity/specificity: Urotron 0.85/0.84, Rapimat 0.91/0.67, Clinitek 0.82/0.81, and duplicate visual reading 0.88/0.67 and 0.91/0.93. Mechanized teststrip reading had no obvious advantage with respect to the time required. We conclude: (i) no improvement in analytical performance or in speed of analysis could be claimed for mechanized methods in comparison with visual reading; (ii) mechanized teststrip reading might decrease the work load of the urine laboratory if integrated into a computerized laboratory system; (iii) mechanized teststrip reading will become analytically advantageous over visual reading if a more refined classification of the results is achieved.

Evaluation Studies as Topic↗

Differences in visuospatial judgement in reading-disabled and normal children.

Both visual and verbal impairments have been reported in two independent streams of research into the etiology of dyslexia or reading-disability. To address the question of the presence of either abnormality in reading-disabled children, visuospatial and phonological ability were assessed and contrasted in 39 Normal and 26 Reading-disabled children. To assess whether these deficits are unique to dyslexia, scores were also compared to those of a group of 12 Poor Readers ("garden-variety" backward readers with low IQs). The Benton Judgement of Line Orientation Test was used for its simplicity and clinical reliability: Reading-disabled subjects performed significantly worse than Normal readers (but similar to Poor Readers). Reading-disabled subjects performed worse for lines in the left-hemifield compared to Normal subjects and also had a greater tendency to scan the task in reverse order (left-to-right) from the usual right-to-left scanning pattern observed in the Normal group when performing this test. When both verbal and visuospatial variables were combined in a multiple regression analysis, 71% of reading variance could be accounted for. These results suggest that Reading-disabled children not only have poor phonological awareness, but they also show visuospatial deficits. However, poor performance on both these tasks was also observed in the group of Poor Readers, suggesting that these deficits are not unique to children with specific reading disability. The results lend further evidence to the hypothesis that reading disability cannot solely be attributed to left-hemisphere dysfunction resulting in phonological impairment. There are other behavioral deficits, possibly caused by a common mechanism, some of which, like visuospatial ability, can be measured by simple behavioral tests such as the Judgment of Line Orientation Test.

Child↗

Hemispheric processing characteristics for lexical decisions in adults with reading disorders.

The present study measured unilateral tachistoscopic vocal reaction times and error responses of reading-disordered and normally reading adults to single words and nonwords in a series of lexical decision tasks at two linguistic levels (concrete and abstract words). Analysis of variance on reaction times indicated that main effects of stimulus type, visual field, and the interaction of these variables were not significant for the reading-disordered group, but visual field and an interaction of visual field and stimulus type were for the normally reading adults. Error rate showed a significant interaction of stimulus x visual field for the reading-disordered group but not for the normal reading group. Post hoc tests showed significant differences in error rates between visual fields for concrete lexicon but not for abstract or nonsense lexicon for the reading-disordered group. These findings suggest a deficit in interhemispheric lexical transfer occurs for reading-disordered samples and suggest use of a callosal relay model wherein the left hemisphere is allocated responsibility for performing central operations underlying lexical decisions by adults with reading disorders.

Adolescent↗

Transfer of lexical information in adults with reading disorders.

This study was designed to test whether adults with reading disorders differ from adults with normal reading abilities in their interhemispheric transfer rates during a lexical decision task. Correlations of performance were completed between lexical decision vocal reaction times (msec.), interhemispheric reaction rates (RVF vocal reaction times-LVF vocal reaction times) and measures of decoding skills, including sight word decoding and phonological decoding for 20 adults with reading disorders and 20 with normal reading abilities. Following a series of Pearson product-moment correlations, the correlation between interhemispheric transfer time and sightword recognition was significant and negative for the adults with reading disorders. This value indicates a significant association between the direction of the interhemispheric transfer time times and sight-word recognition for reading-disordered adults. When correlations were negative (LVF) reaction times < RVF reaction times), stronger sight-word recognition scores were found. The correlation between interhemispheric transfer time and sight-word recognition was not significant for the normal reading adults. For both groups, the correlations between interhemispheric transfer time and phonological decoding were not significant so an association between phonological decoding and interhemispheric transfer time was not evident, The current findings suggest a strong relationship between reading proficiency and reaction times in completing the lexical decision task for the reading-disordered adults.

Adolescent↗

Radiographs in the office: is a second reading always needed?

BACKGROUND: We evaluated the frequency, nature, and importance of the changes in patient care that occurred as a result of differences in outpatient radiograph readings for cases in which the primary care clinician, hypothetically, would not request a second reading by a radiologist. METHODS: During 4 months, 1393 pairs of radiographic readings were collected from 9 volunteer primary care practices with 86 clinicians and a second reading by one of 42 radiologists. For 553, hypothetically, the clinician would not request a consultation from a radiologist. Review analysis of the 553 pairs revealed 100 (18.1%) radiographs in which the radiologist's reading did not agree with the clinician's reading. Data from the original visit and subsequent related care were abstracted from patient charts and reviewed. Changes in clinical care resulting from the radiologist's reading were identified. RESULTS: The radiologists' second reading of these 553 sets of radiographs resulted in 14 (2.5% of 553 and 14% of 100) cases of one or more changes in care. We found 38 documented or presumed changes in care and zero substantial changes in care. CONCLUSIONS: Primary care clinicians are able to identify radiographs for which a second reading by a radiologist will not result in substantial changes in care.

Clinical Competence↗

[The assessment of the impact of a double reading by expert readers in a mass mammographic study].

PURPOSE: To evaluate the role of double reading of screening mammograms by expert radiologists. MATERIAL AND METHODS: We analyzed the results of independent readings of a proficiency test of screening mammography (140 cases, 32 cancers) performed by four expert radiologists. Double reading was simulated by matching the four original readings in 6 possible combinations. The impact of double reading over single reading was evaluated in terms of increased sensitivity and increased recall rate. RESULTS: Of 32 carcinomas 22, 6, or 4 were identified by 4, 3, or 2 readers, respectively. Of 108 cases negative for cancer a recall for further investigations was suggested by 4, 3, 2, 1 or no reader(s) in 3, 3, 9, 14, or 79 cases, respectively. Inter-reader diagnostic repeatability was good (k = 0.65). Single readers achieved an average sensitivity of 89% (range 87.5-90.6%) and an average recall rate of 12.2% (range 7.4-16.6%). Simulated double reading achieved an average increase in sensitivity of 8.8% (range 6.2-10.95%) and an average increase of recall rate of 6.2% (range 3.8-8.3%). CONCLUSIONS: Even though the relative increase of recall rate is relevant (+53.2%), the corresponding gain in sensitivity justifies the use of double reading, which was confirmed to be worthwhile also when expert radiologists are involved. This study confirms the opportunity of adopting double reading as a routine procedure in mammographic screening.

Aged↗

The role of dominant premotor cortex and grapheme to phoneme transformation in reading epilepsy. A neuroanatomic, neurophysiologic, and neuropsychological study.

We studied a 24-year-old man who had reading epilepsy after removal of a left frontal arteriovenous malformation. Lesion analysis by means of a neuroanatomic template placed a 2-cm region of encephalomalacia anterior to the left central sulcus in premotor cortex (Brodmann's area 6). Lexical and nonlexical reading activation tests demonstrated seizures during reading and increased discharge rates when the patient was reading aloud or silently articulating. Seizures (perceived or actual jaw clicking) were electrographically characterized by brief left frontocentral epileptiform transients. Grapheme to phoneme transformation, not linguistic complexity, appears to be the critical stimulus in some reading epilepsies. The case adds anatomic relevance to the phonologic component of reading and supports the putative role of dominant premotor cortex in activation of precise sequences of motor linguistic output in reading and writing. Reading epilepsy may be a reflex or action myoclonus syndrome localized to Brodmann's area 6 (Exner's area).

Adult↗

Visual field loss in primary gaze and reading gaze due to acquired blepharoptosis and visual field improvement following ptosis surgery.

Acquired blepharoptosis has been associated with loss of the superior visual field (SVF) in primary gaze. Because many patients with acquired blepharoptosis complained of difficulty reading or performing other visual functions in reading gaze, a prospective study was undertaken to determine if acquired blepharoptosis was the cause of these visual dysfunctions. Preoperative and postoperative SVFs were tested in primary gaze and reading gaze in 19 patients with unilateral or bilateral acquired blepharoptosis totaling 30 eyes. Preoperative testing revealed a marked loss of the SVF in both primary gaze and reading gaze. All patients underwent levator aponeurosis defect repair. Postoperative results showed a significant improvement in both primary and reading gaze SVFs. Therefore, patients with good visual acuity complaining of difficulty reading or carrying out other visual functions in reading gaze should be examined for the presence of acquired blepharoptosis. Blepharoptosis repair can be expected to improve the SVF in both primary gaze and reading gaze.

Adult↗

Reading level of the Dissociative Experiences Scale.

Reading difficulty values based upon the Flesch reading grade level and reading ease score (Flesch, 1949) were calculated for the 28 items of the Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986). Item reading levels ranged from the sixth to more than the thirteenth grade. According to the reading level formula, 43% of the items required at least a high school education. The reading ease estimate suggested that only 1 item required at least 12 years of schooling. Overall, a tenth- to eleventh-grade reading level was required for the entire DES. For persons with confirmed or suspected reading difficulties, interpretation of the DES should be made cautiously.

Dissociative Disorders↗

Visual and auditory temporal processing and early reading development.

This study investigated the ability of temporal processing measures obtained before school entry to predict early reading development in an unselected sample of 125 children (68 males, 57 females). Visual and auditory temporal order judgement (TOJ) tasks measured at Preschool (mean age 5.36 years) significantly predicted letter and word identification (accuracy) and reading rate (fluency) in early Grade 1 (mean age 5.94 years), even after the effects of age, environment, memory, attention, nonverbal ability, and speech/language problems were accounted for. There were no significant differences in the overall variance accounted for in reading between TOJ measures taken before or after reading had emerged. Both Preschool and Grade 1 measures of auditory TOJ accounted for significant independent variance in reading. However, only visual TOJ performance measured at Grade 1 accounted for unique variance in reading rate. This was discussed in terms of developmental changes in the role of visual temporal processing as reading develops. Reliability of the temporal measures from Preschool to Grade 1 was moderate. The results showed that measures of visual and auditory temporal processing obtained close to school-entry would be a useful addition to predicting risk of early reading difficulties.

Attention↗

Specific cerebellar activation during Braille reading in blind subjects.

The traditional view that the cerebellum is involved only in the control of movements has been changed recently. It has been suggested that the human cerebellum is involved in cognition and language. Likewise, besides cortical activity in sensorimotor and visual areas, an increased global activation of the cerebellum has been revealed during Braille reading in blind subjects. Our purpose was to investigate whether there is cerebellar activation during Braille reading by blind subjects other than sensorimotor activation related to finger movements. Early blind and normal sighted subjects were studied with functional magnetic resonance imaging (fMRI) during Braille reading, tactile discrimination of nonsense dots, dots forming symbols, and finger tapping. The experiments were done in block design. Echo planar imaging sequences were carried out on a 1.5-T MR scanner. All blind individuals reading Braille showed robust activation of the posterior and lateral aspects of cerebellar hemispheral lobules Crus I bilaterally but more predominately on the right side. Additionally, activation was present in the medial cerebellum within lobules IV, V, and VIIIA, predominantly on the right. Discriminating nonsense dots did not reveal any activation of Crus I, but did reveal activation within the medial part of lobules IV, V, and VIIIA, predominately on the right. Analysis of sighted subjects during reading of printed text revealed activation of the posterolateral cerebellar hemisphere in Crus I bilaterally, predominantly on the right. Tactile analysis of dots representing symbols revealed an activation in lobules IV and VIII and in right Crus II but not in Crus I. In conclusion, parts of cerebellar activation during Braille reading in blind subjects (i.e., within lobules IV, V, and VIII) overlap with the known hand representation within the cerebellum and are likely related to the sensorimotor part of the task. Cerebellar activation during Braille reading within bilateral Crus I may be due to language processes or inner speech similar to those found during text reading in normal sighted subjects. Object recognition did not account for Crus I activation.

Adaptation, Physiological↗