Article for Category: ‘Learning Difficulties – General’

Does medication improve reading ability?

September 05th, 2016

The Journal of Child and Adolescent Psychopharmocology has published an article by Shaywitz et al that investigated the affects of the drug atomoxetine (sold as Strattera) on reading and attention in children with dyslexia, ADHD and comorbid dyslexia + ADHD.

My understanding is that the experiment was part of a broader study on the effectiveness of atomoxetine as a treatment for ADHD. The study appears to have been funded by Eli Lilly and the second author is reportedly an employee and minor shareholder in Eli Lilly.

Children were defined as having dyslexia if (a) there was at least a 22-point discrepancy (approx. 43 percentile ranks) between IQ and word-reading ability (defined by the WJIII Word Attack test OR the Word Identification OR the WJIII Basic Reading Cluster – an average of Word Attack and Word Id) or (b) the child had a standard score of 89 or lower on at least one of the WJIII tests.

The first thing that springs to mind is that these criteria are not particularly stringent. A standard score of 89 represents the 23rd percentile. It is still within a standard deviation of the mean. Further, the discrepancy criterion presumably means that a child with an IQ score of 122 and a reading score of 100 (exactly average) met criteria for the dyslexia group.

Using these criteria, 209 children who were allocated at random to an atomoxetine or placebo group. Numbers in each group were: dyslexia only (n = 29 atomoxetine, n = 29 placebo), ADHD + dyslexia (n = 64 atomoxetine, n = 60 placebo) and ADHD only (all of whom received atomoxetine).

The drug trial lasted for 16-weeks. Changes in reading skills were measured by:

WJIII Word Attack and Word Identification tests

WJIII Spelling

WJIII Reading Comprehension and Reading Vocabulary

Comprehensive Test of Phonological Processing (CTOPP)

Gray Oral Reading Tests-4 (GORT-4)

Test of Word Reading Efficiency (TOWRE)

It is unclear why but on many variables the Placebo group had higher pre-treatment reading/spelling skills than the Atomoxetine group. For example, within the Dyslexia only group the Placebo sub-group had an average standard score on the Word Attack subtest of 88.05 while the Atomoxetine group had an average score of 84.11. It was 83.86 vs 80.47 for Word Identification, 83.32 vs 77.32 for Spelling. This may seem a minor point but consider the effect of regression to the mean http://www.understandingminds.com.au/blog/2012/02/. The more extreme a score is at pre-test the more likely it is to “bounce’ back towards average at post-testing. Thus, the Atomoxetine group was more likely to “benefit” from regression effects than the Placebo group.

A summary of the interesting bits of the results:

  • Children with dyslexia who were treated with atomoxetine made greater gains than children with dyslexia given the placebo treatment on WJIII Word Attack, WJIII Basic Reading Cluster and WJIII Reading Vocabulary.
  • Children with dyslexia + ADHD who were treated with atomoxetine made greater gains than children with dyslexia + ADHD given the placebo treatment on the CTOPP Elision test (a peripheral/distal reading sub-skill).

So what?

  1. At first glance it seems odd that children with dyslexia would respond better to a medication designed for ADHD than children who actually had ADHD. However, there are reasonable explanations. First, medication isn’t a panacea. It doesn’t cure ADHD. It improves symptoms. It is possible that the ADHD + dyslexia remained more impaired than the dyslexia group even when given medication. Second, children with dyslexia often have sub-threshold symptoms of ADHD that may in fact respond better to medication than the more severe symptoms seen in children actually diagnosed with ADHD.
  2. It is possible that at least some of the effects were due to greater regression to the mean in the Atomoxetine vs Placebo group (see above).
  3. It is possible that the medication simply improved test behaviour rather than reading ability per se.

The data are arguably the beginning of a research journey. They provide some preliminary support for the idea that psycho-stimulant medication can improve academic skills even in children without ADHD. However, I am sceptical about this. I can see how medication might improve test-taking behaviour in some children. I can also see how it might “smooth out” the inconsistency seen in children with attention problems and with dyslexia. However, medication doesn’t teach. It doesn’t matter how good your attention is; if you don’t know it you don’t know it.

I am more interested in how medication affects response to reading intervention. The graph below shows data from a single case seen in my clinic. The case is of a male with ADHD + mixed dyslexia. He was receiving reading intervention delivered 4/week. See here http://sgo.sagepub.com/content/spsgo/1/2/2158244011420452.full.pdf and here http://sgo.sagepub.com/content/early/2011/11/01/2158244011428159 for descriptions of the program.

 

The data points represent a weekly nonword reading test. The test items were constructed using the grapheme-phoneme conversion rules taught in the intervention program. If the student learns ~4-5 new GPCs weekly they should be able to read ~5 extra nonwords each week. The “flat lines” represent data from 2 x baseline periods and 2 x treatment periods in which the participant was receiving reading intervention only. One can see that not much progress was being made. It wasn’t that the boy wasn’t learning new things. It was more than his “recall” was inconsistent and his test-taking behaviour was poor.

Upwards growth in test scores were seen almost immediately upon beginning to take a stimulant medication. Later data, not shown in the graph, showed that removing the reading intervention so the only treatment was medication resulted in a return to a flat line. That is, the medication didn’t teach skills.

We have seen this pattern in several cases now; although the results of other cases have not been as dramatic as this first case.  (I should also point out that the skeptic in me thinks that these data are too perfect and I need to see them replicated before I truly “believe” them).

Our very preliminary conclusions are that attention is necessary for new learning to take place and that the medication helps set the conditions for learning to happen (the batter into which the teaching is stirred if you will). However, medication will probably not make you a good reader sans the teaching.

At this point there is no justification for trialling medication in students who just have dyslexia. However, we hope to see a larger trial of the response of students with ADHD + dyslexia to reading intervention versus medication + reading intervention.

For help with dyslexia, ADHD, autism spectrum disorders and other developmental and learning disorders in the Gold Coast and Tweed regions contact the Understanding Minds Clinic.

 

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Similar but different: differences in comprehension diagnosis on the Neale Analysis of Reading Ability and the York Assessment of Reading for Comprehension

May 04th, 2016

Psychometric tests are behavioural tests. We use measures of behaviour (which we can see directly) to infer something about a latent variable (something that can’t be seen or measured directly). Take tests of reading ability as an example. Reading occurs in the brain and is therefore a latent variable. We can’t see or measure it directly. The consequence is that different tests will provide different results depending on a number of factors, including the skills/items that the test samples and the normative population. 

Danielle ColenbranderLyndsey Nickels and Saskia Kohnen have just published a study that investigated differences in the content and scores obtained from two commonly used reading tests: The NARA and the YARC. The whole can be found in the Journal of Research in Reading. 

The Abstract

Identifying reading comprehension difficulties is challenging. There are many comprehension tests to choose from, and a child’s diagnosis can be influenced by various factors such as a test’s format and content and the choice of diagnostic criteria. We investigate these issues with reference to the Neale Analysis of Reading Ability (NARA) and the York Assessment of Reading for Comprehension (YARC).

Methods

Ninety-five children were assessed on both tests. Test characteristics were compared using Principal Components and Regression analyses as well as an analysis of passage content.

Results

NARA comprehension scores were more dependent on decoding skills than YARC scores, but children answered more comprehension questions on the NARA and passages spanned a wider range of difficulty. Consequently, 15–34% of children received different diagnoses across tests, depending on diagnostic criteria.

Conclusion

Knowledge of the strengths and weaknesses of comprehension tests is essential when attempting to diagnose reading comprehension difficulties.

 

For help with dyslexia, ADHD, autism spectrum disorders and other developmental and learning disorders in the Gold Coast and Tweed regions contact the Understanding Minds Clinic.

Like us on Facebook for updates on dyslexia related matters, information on other developmental disorders like autism spectrum disorders, Asperger’s and ADHD, and general mental health info.

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Abstract Tuesday: A Taxometric Investigation of Developmental Dyslexia Subtypes

May 14th, 2013
Dyslexia

O’Brien et al. (2012). A Taxometric Investigation of Developmental Dyslexia Subtypes. Dyslexia, 18, 16-39.

Keywords:

  • developmental dyslexia;
  • subtypes;
  • double deficit hypothesis;
  • taxometric analysis

Long-standing issues with the conceptualization, identification and subtyping of developmental dyslexia persist. This study takes an alternative approach to examine the heterogeneity of developmental dyslexia using taxometric classification techniques. These methods were used with a large sample of 671 children ages 6–8 who were diagnosed with severe reading disorders. Latent characteristics of the sample are assessed in regard to posited subtypes with phonological deficits and naming speed deficits, thus extending prior work by addressing whether these deficits embody separate classes of individuals. Findings support separate taxa of dyslexia with and without phonological deficits. Different latent structure for naming speed deficits was found depending on the definitional criterion used to define dyslexia. Non-phonologically based forms of dyslexia showed particular difficulty with naming speed and reading fluency.

Practitioner Points

  • Support for separate subtypes of dyslexia, with and without phonological deficits (PDs), indicates a need for different approaches to intervention.
  • A discrepancy-based criterion identifies more non-PD cases that may be missed with a response-to-intervention diagnosis.
  • Sound symbol correspondence and decoding measures may best distinguish cases of dyslexia with and without PDs.

 

For help with dyslexia on the Gold Coast and Tweed regions contact the Understanding Minds Dyslexia & Reading Difficulties Clinic .

Like us on Facebook for updates on dyslexia related matters, information on other developmental disorders like autism spectrum disorders, Asperger’s and ADHD, and general mental health info.

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The influence of whole language philosophy on classroom reading strategies

February 20th, 2013

Click to download  reading strategies. The link will take you to another page. Click on the ‘reading strategies’ file name a second time to download the PDF.

 

For help with dyslexia on the Gold Coast and Tweed regions contact the Understanding Minds Dyslexia & Reading Difficulties Clinic .

Like us on Facebook for updates on dyslexia related matters, information on other developmental disorders like autism spectrum disorders, Asperger’s and ADHD, and general mental health info.

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Autism, Asperger’s, Disability and related blogs

January 30th, 2013

Abnormal Diversity
Action for Autism
Adventures In Extreme Parenting
Along The Spectrum
Andrea’s Buzzing About
The Art of Being Asperger Woman
Ask An Aspie
The ASMan
Asperger Square 8
Asperger’s Conversations
Aspergers Parallel Planet
Aspie Dad
Aspie Home Education
ASPIES
Aspies For Freedom
Autiemom Speaks Out
Autism All The Time
Autism & Computing
Autism Blog
The Autism Crisis: Science & Ethics of Autism Advocacy
Autism Diva
Autism Natural Variation
Autism Podcast
Autism Squeaks
Autism Street
Autism Vox
Autism Watch
Autism’s Edges
Autismland
AutisMusic
Autistic Adults Picture Project
Autistic Advocacy
Autistic Conjecture of the Day
Autistic Dad
Autistic Health
Autistics.org
Ballastexistenz
Bartholomew Cubbins on Autism
Biodiverse Resistance
Chewing the Fat
Club 166
Commentary on the State of the World
Countering Age of Autism
Deconstructing Neurelitism
Desperately Seeking Ethics & Reason
Detritus
dkmnow
Ed’s Blog
The Family Voyage
Greener Pastures
Grey Matter/White Matter
Hard Won Wisdom
Hazardous Pastimes
Hollywood Spectrum
Homo Autistic
Hyperlexia
Hypnagogic Malcontent
I Speak of Dreams
Ian Johnson’s neurodiversity blog
in regione caecorum rex est luscus
Incorrect Pleasures
Interverbal
iRunman Blog
Jedi Workshop
Jenny McCarthy Body Count
The Joy of Autism
Killer of Sacred Cows
The Kingdom of Laurentius Rex
Left Brain/Right Brain
Life in the New Republic
A Life Less Ordinary
The Life That Chose Me
Mainstream Parenting
Memory Leaves
meow meow meow… blah blah blah
Misadventures from a Different Perspective
The Misbehaviour of Behaviourists (Discussion Board)
Mom Not Otherwise Specified
Mom to Mr. Handsome
More Than a Label
Mother of Shrek
My Act of Combating Neurobigotry
My Son Has Autism
My Son’s Autism
Neurotypicals Are Weird
No Autistics Allowed
Not Mercury
OASIS
Odd One Out
Oddizms
One Dad’s Opinion
Parenting a Complex Special Needs Child
PosAutive
Pre-Rain Man Autism
Processing in Parts
The “R” Word
Radio Calico
Ragged Edge
Random Reminiscing Ramblings
The Rettdevil’s Rants
Room 36
Sam I Am
Shh… Mum Is Thinking
Silver Cuckoo
Slurping Life
Snippets: Short Takes on Autistic Topics
So Much For Mercury
Stop. Think. Autism.
Susan Senator
Sweet Perdition
This Mom
This Mom
This Way of Life
A Touch of Alyricism
Touched by an Alien
Touched By An Alien
Translating Autism: Autism Research
29 Marbles
Unstrange Minds
Victoria’s Corner
We Go To School To Think
What Sorts of People…?
Whirled Peas
Whitterer on Autism
Whose Planet Is It Anyway?
Wikipedia on Neurodiversity
Zoe Notes

For help with autism spectrum conditions, ADHD and dyslexia on the Gold Coast and Tweed regions contact Understanding Minds.

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