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Identifying Signs of Dyslexia Test: Evidence of Criterion Validity1 1 Support: Article derived from the doctoral thesis of the first author under the supervision of the second, defended in 2016, in the Graduate Program in Psychology at the Pontifícia Universidade Católica de Campinas. Financial support from the National Council for Scientific and Technological Development (CNPq), case No. 140281/2014-2.

Teste para Identificação de Sinais de Dislexia: Evidências de Validade de Critério

Test para la identificación de Señales de Dislexia: Evidencia de la Validez de Criterio

Abstract

In Brazil, there is a lack of valid instruments for screening for Developmental Dyslexia (DD) and so the aim of this study was an in-depth investigation of evidence of validity based on the relations with external variables for the Identifying Signs of Dyslexia Test (TISD). More specifically, it seeks to investigate the validity of the criterion, i.e. whether such instruments would be capable of identifying this diagnosis. The research involved comparing two samples: (a) children with DD diagnosis (n = 15) and (b) children without complaints of reading and writing difficulties (n = 146). It was found that in all the subtests of which the instrument is made up (reading, writing, visual attention, calculation, motor skills, phonological awareness, rapid naming, short term memory) there were significant differences between the groups, and in the test total. The results suggest that the TISD was able to identify the group with DD, evidencing the validity of the criterion for this instrument.

Keywords:
psychometry; learning; neuropsychology; psychological evaluation

Resumo

No Brasil há escassez de instrumentos validados para triagem da Dislexia do Desenvolvimento (DD), dessa forma, o presente estudo objetivou investigar mais profundamente evidências de validade baseadas nas relações com variáveis externas para o Teste para Identificação de Sinais de Dislexia (TISD). Especificamente, buscou-se investigar a validade de critério, ou seja, se tal instrumento seria capaz de identificar esse diagnóstico. A pesquisa envolveu a comparação de duas amostras: (a) crianças com diagnóstico de DD (n = 15) e (b) crianças sem queixas de dificuldades em leitura e escrita (n = 146). Verificou-se que em todos os subtestes que compõem o instrumento (leitura, escrita, atenção visual, cálculo, habilidades motoras, consciência fonológica, nomeação rápida, memória de curto prazo) houve diferenças significativas entre os grupos, bem como no total do teste. Os resultados sugeriram que o TISD foi capaz de indicar o grupo com DD, o que evidencia validade de critério para tal instrumento.

Palavras-chave:
psicometria; aprendizagem; neuropsicologia; avaliação psicológica

Resumen

En Brasil hay escasez de instrumentos validados para clasificar la Dislexia del Desarrollo (DD), de esta forma, el presente estudio objetivó investigar más profundamente evidencias de validez basadas en las relaciones con variables externas para la Prueba para Identificación de Señales de Dislexia (PISD). Específicamente, se buscó investigar la validez de criterio, o sea, si tal instrumento fuera capaz de identificar ese diagnóstico. La investigación incluyó la comparación de dos muestras: (a) niños con diagnóstico de DD (n = 15) y (b) niños sin quejas de dificultades en lectura y escritura (n = 146). Se verificó que en todas las subpruebas que componen el instrumento (lectura, escrita, atención visual, cálculo, habilidades motoras, conciencia fonológica, nombramiento rápido, memoria de corto plazo) hubo diferencias significativas entre los grupos, así como en el total de la prueba. Los resultados sugirieron que la PISD fue capaz de indicar el grupo con DD, que evidencia validez de criterio para tal instrumento.

Palabras clave:
psicometría; aprendizaje; neuropsicología; evaluación psicológica

Learning disorders are changes in neurodevelopment that present as essential persistent difficulties in the learning of academic abilities, such as reading, writing and calculation (World Health Organization [WHO], 2008). Affected individuals may show poor performance in one or more of these abilities, which is not explained by lack of schooling, intellectual disability or uncorrected sensory changes. Specifically, the disorder with reading impairment can also be termed Developmental Dyslexia - DD (American Psychiatric Association [APA], 2013American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-V (5th ed.). Washington, DC: Author.).

Diagnostic manuals propose that diagnosis of DD be made after beginning formal education, based on the following criteria: (a) oral reading characterized by distortions, omissions and substitutions; (b) reduced reading speed, with misunderstandings; (c) impairment in the development of reading skills, with lower performance than expected for age, schooling and intelligence in standardized tests (APA, 2013American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-V (5th ed.). Washington, DC: Author.; OMS, 2008Organização Mundial de Saúde. (2008). CID-10: Classificação de transtornos mentais e de comportamento: Descrições clínicas e diretrizes diagnósticas [ICD-10: Mental disorders classification and behavior: Clinical descriptions and diagnostic guidelines]. Porto Alegre, RS: Artes Médicas.).

Some of these tests for screening have been described in the literature. Internationally, there is the International Dyslexia Test (IDT), drawn up by Smythe and Everatt (2000Smythe, I., & Everatt, J. (2000). International Dyslexia Test (IDT). Guildford, United Kingdom: University of Surrey.). This instrument enables extensive investigation of different cognitive-linguistic abilities, such as reading, writing, mathematical skills, phonological awareness, auditory processing, phonological discrimination, short-term memory, auditory sequential memory, visual processing, visual discrimination and perception, sequential memory visual, processing speed, motor skills and reasoning. Another instrument is the Test of Dyslexia and Dysgraphia (TODD), by Cox (2002Cox, E. A. (2002). An evaluation of the psychometric properties of the test of dyslexia e dysgraphia (Unpublished doctoral dissertation). University of Tennessee, Knoxville, TN.), which aims to aid diagnosis of DD and dysgraphia, evaluating memory of symbols and words, phonological skills, visual processing and rapid naming of symbols. There is also the Dyslexia Early Screening Test (DEST-2), by Nicolson and Fawcett (2004Nicolson, R. I., & Fawcett, A. J. (2004). Dyslexia Early Screening Test - Second Edition (DEST-2). London, United Kingdom: Pearson.), which indicates risk of learning disorder based on evaluating the skills of rapid naming, phonemic discrimination, postural stability, rhyme, digits, naming digits, naming letters, ordering sounds, copying forms, attention, vocabulary, visual-motor coordination.

In the Brazilian context, there is a shortage of instruments for this purpose. A preliminary study for standardizing IDT (Smythe & Everatt, 2000Smythe, I., & Everatt, J. (2000). International Dyslexia Test (IDT). Guildford, United Kingdom: University of Surrey.) was undertaken by Capovilla Smythe, Capovilla and Everatt (2001Capovilla, A. G. S., Smythe, I., Capovilla, F. C., & Everatt, J. (2001). Adaptação brasileira do International Dyslexia Test: Perfil cognitivo de crianças com escrita pobre [Brazilian adaptation of the international dyslexia test: Cognitive profile of children with poor writing]. Temas sobre Desenvolvimento, 10(57), 30-37.), based on evaluation of the same abilities that make up the original instrument. Later, Capellini and Smythe (2008Capellini, S. A., & Smythe, I. (2008). Protocolo de avaliação de habilidades cognitivo-linguísticas: Livro do profissional e do professor [Evaluation protocol of cognitive-linguistic skills: Professional book and teacher]. Marília, SP: Fundepe.) published the protocol of cognitive-linguistic abilities, also based on the IDT, which evaluates reading, phonological awareness, auditory processing, visual processing and processing speed. Capellini et al. (2009Capellini, S. A., Sampaio, M. N., Fukuda, M. T. M., Oliveira, A. M., Fadini, C. C., & Martins, M. A. (2009). Protocolo de identificação precoce dos problemas de leitura: Estudo preliminar com escolares de 1º ano escolar [Early identification of reading problems: Preliminary study with students of 1st grade]. Revista Psicopedagogia, 26(81), 367-375. Retrieved from http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0103-84862009000300004
http://pepsic.bvsalud.org/scielo.php?scr...
) proposed the protocol for early identification of reading problems in 1st grade students to assess cognitive-linguistic abilities of alphabet knowledge, phonological awareness, rhyming production and identification, syllabic segmentation, word production based on given phoneme, phonemic synthesis and analysis, identification of initial sound, working memory, visual attention, speed of access to phonological information, reading of words and nonwords, and comprehension of phrases from the figures presented. However, studies searching for evidence of validity of all these instruments for the Brazilian population have not been finalized.

Recently, the Identifying Signs of Dyslexia (TISD) (RJR Alves, Lima, Salgado-Azoni, Carvalho, & Ciasca, 2015Alves, R. J. R., Lima, R. F., Salgado-Azoni, C. A., Carvalho, M. C., & Ciasca, S. M. (2015). Identifying Signs of Dyslexia Test (TISD): The construction process. Estudos de Psicologia (Campinas), 32(3), 383-393. doi: 10.1590/0103-166X2015000300004
https://doi.org/10.1590/0103-166X2015000...
) aimed to evaluate academic and neuropsychological abilities that are currently impaired in children with DD (Figure 1). The TISD consists of 8 subtests: (1) Reading; (2) Writing; (3) Attention; (4) Calculation; (5) Motor Skills; (6) Phonological Awareness; (7) Rapid Naming; (8) Short Term Memory. The construction of its activities and the choice of skills to be evaluated were based on national and international publications focused on the evaluation of DD.

In order to make TISD available in educational and clinical contexts, psychometric studies guaranteeing its validity, have yet to be performed. Specifically, validity refers to the proof that the test actually measures what it aims to measure (Kline, 2015Kline, P. (2015). A handbook of test construction (psychology revivals): Introduction to psychometric design. New York, NY: Routledge.). The most recent classification indicates five types of validity investigation/evidence: (a) evidence based on relationships with external variables, (b) evidence based on internal structure, (c) evidence based on the response process, (d) evidence based on the consequences of testing, and (e) content-based evidence (American Educational Research Association [AERA], American Psychological Association [APA], National Council on Measurement in Education [NCME], 2014American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: AERA.).

Some studies have already been conducted to investigate evidence of validity of the TISD. Initially, in its construction process, the draft was evaluated by expert judges to investigate evidence of content-based validity. The aim was to verify whether the selected skills and tasks performed were related to the evaluated construct, and favorable results were found (R.J.R. Alves et al., 2015Alves, R. J. R., Lima, R. F., Salgado-Azoni, C. A., Carvalho, M. C., & Ciasca, S. M. (2015). Identifying Signs of Dyslexia Test (TISD): The construction process. Estudos de Psicologia (Campinas), 32(3), 383-393. doi: 10.1590/0103-166X2015000300004
https://doi.org/10.1590/0103-166X2015000...
).

In a later study, we investigated evidence based on relationships with external variables, by comparing groups (criterion validity) and convergent validity analysis (which aims to collect data on correlation patterns between the test scores with other, already validated, test scores measuring the same construct or related constructs) (MN Alves et al., 2013Alves, M. N., Lima, R. F., Alves, R. J. R., Salgado-Azoni, C. A., Nakano, T. C., & Ciasca, S. M. (2013). Estudo piloto de validação do teste de identificação de sinais de dislexia (TISD) [Validation pilot study of the identifying signs of dyslexia test (TISD)]. Estudos Interdisciplinares em Psicologia, 4(2), 217-239. doi: 10.5433/2236-6407.2013v4n2p217
https://doi.org/10.5433/2236-6407.2013v4...
). It compared groups of children with (n = 11) and no schooling complaints (n = 9) and performed correlation analyses between some of the TISD subtests with the School Performance Test (TDE) subtests (Stein, 1994Stein, L. M. (1994). Teste de desempenho escolar [School achievement test]. São Paulo, SP: Casa do Psicólogo.). Significant differences were found between the two groups in the total TISD score and in the reading, writing, calculation, phonological awareness and working memory subtests, with poorer performance in the group with learning disabilities. Statistically significant, moderate, and high correlations between TISD and TDE subtests were observed (TISD ReadingxTDE Reading: r = -0.70; TISD WritingxTDE Writing: r = -0.88; TISD CalculationxTDE Arithmetic r = -0.73). Thus, initial evidence of validity was found based on relations with external variables.

Considering the favorable results found in preliminary studies, this study aimed to investigate in-depth validity evidence based on relations with external variables for the TISD. Specifically, we sought to investigate the criterion validity (Kline, 2015Kline, P. (2015). A handbook of test construction (psychology revivals): Introduction to psychometric design. New York, NY: Routledge.), that is, whether such instruments would be able to identify this diagnosis. For this, the procedure adopted was to compare a group of children with such diagnosis to a group of children without complaints of reading and writing difficulties.

Method

Participants

The sample consisted of two groups: Case Group (CG, composed of children diagnosed with Developmental Dyslexia) and No Case Group (NG, children with no complaints of reading and writing difficulties). The CG was composed of 15 children and the NG of 146, the selection criteria of which are shown in the procedures section.

The age group of the CG was 8 to 12 years (M = 9.80, SD = 0.94), of whom eight were male (58.3%). The age range of NG was between 8 and 11 years (M = 9.28; SD = 0.86), 63 males (43.2%). The mean age of both groups was compared using the Mann-Whitney test, and a statistically significant difference was found (U = 775.50, p = 0.049). When comparing the sexes, using the chi-square test, no differences were found (χ2 = 0.572, p = 0.587).

Among children in the CG, seven were in the fifth year of school (46.7%), five in the fourth year (33.3%), two in the third year (13.3%), and one in the sixth (6.7%). Furthermore, eleven attended public school (73.3%) and four private school (26.7%). The majority of the NG sample was in the fourth year (n = 58, 39.7%), followed by the fifth year (n = 57, 39%), and the third year (n = 31, 21.2% ). A large part attended public school (n = 107; 73.3%). When comparing school years between groups, no statistically significant difference was observed (Fisher’s test, p = 0.146). Likewise, when comparing the type of school, no difference was found (Fisher test, p = 0.632).

Instrument

Questionnaire for parents/guardians and Questionnaire for teacher. Composed of five open questions seeking to investigate the following characteristics: profile of reading and writing school skills and some common mistakes made by children with DD; possible neuropsychiatric disorders, mood, mental or genetic syndromes; use of psychotropic medication; repeating school year. A table was also drawn up with the diagnostic criteria for DD, in which it was requested to indicate whether the child met certain criteria or not; a questionnaire was filled out for each child. Average application time: 15 minutes.

Identifying Signs of Dyslexia Test (TISD) (R. J. R. Alves et al., 2015Alves, R. J. R., Lima, R. F., Salgado-Azoni, C. A., Carvalho, M. C., & Ciasca, S. M. (2015). Identifying Signs of Dyslexia Test (TISD): The construction process. Estudos de Psicologia (Campinas), 32(3), 383-393. doi: 10.1590/0103-166X2015000300004
https://doi.org/10.1590/0103-166X2015000...
) (Table 1). It consists of a screening instrument aiming to evaluate signs indicative of DD. It is aimed at the 6 to 11 year-old age group, applied individually, with an average duration of 25 minutes. The TISD consists of 8 subtests evaluating both academic skills (reading, writing, calculus) and neuropsychological abilities related to written language (visual attention, motor skills, phonological awareness, rapid naming and short-term memory - it should be pointed out that initially, in previous studies, this last subtest was known as “working memory”).

Table 1
TISD Composition (R. J. R. Alves et al., 2015Alves, R. J. R., Lima, R. F., Salgado-Azoni, C. A., Carvalho, M. C., & Ciasca, S. M. (2015). Identifying Signs of Dyslexia Test (TISD): The construction process. Estudos de Psicologia (Campinas), 32(3), 383-393. doi: 10.1590/0103-166X2015000300004
https://doi.org/10.1590/0103-166X2015000...
)

The score is calculated based on the mistakes made, so that the higher the child’s score, the worse is the performance. It is organized in four materials: “Instructions booklet for application and scoring”, “Answer sheet”, “Application book” and “Stimulus booklet”.

The TISD was constructed in two stages. Initially, a review of the national and international literature was conducted to survey the main school and neuropsychological skills in DD assessment instruments. Based on this, the eight subtests composing the TISD were defined. The second stage consisted of composing the instrument: formulation of the items, instructions, administration procedures, preparation of the stimulus material, construction of the preliminary version and analysis of content by expert judges (R.J.R. Alves et al., 2015Alves, R. J. R., Lima, R. F., Salgado-Azoni, C. A., Carvalho, M. C., & Ciasca, S. M. (2015). Identifying Signs of Dyslexia Test (TISD): The construction process. Estudos de Psicologia (Campinas), 32(3), 383-393. doi: 10.1590/0103-166X2015000300004
https://doi.org/10.1590/0103-166X2015000...
)

In a pilot study conducted by M.N. Alves et al. (2013Alves, M. N., Lima, R. F., Alves, R. J. R., Salgado-Azoni, C. A., Nakano, T. C., & Ciasca, S. M. (2013). Estudo piloto de validação do teste de identificação de sinais de dislexia (TISD) [Validation pilot study of the identifying signs of dyslexia test (TISD)]. Estudos Interdisciplinares em Psicologia, 4(2), 217-239. doi: 10.5433/2236-6407.2013v4n2p217
https://doi.org/10.5433/2236-6407.2013v4...
) initial evidence of validity was verified based on relations with external variables. The TISD was able to differentiate between groups with (n = 11) and without learning difficulties (n = 9). Statistically significant and high negative correlations were observed between TISD and TDE subtests that evaluated the same ability (Reading r = -0,70; Writing r = -0.88; Calculus/Arithmetic r = -0.73).

Procedure

Data collection. Data from the CG group were collected at the Clinical Hospital of the State University of Campinas (UNICAMP), in the “Neuro-Learning Difficulties” outpatient clinic. There, the children first underwent a neuropsychological evaluation in which a battery of instruments were applied.

After this first stage of attending the outpatient clinic, and specifically investigating the reading and writing and neuropsychological difficulties, the team psychologists referred the children for interdisciplinary evaluation and the diagnosis was finalized, including that of DD. In cases where such diagnosis was confirmed, the parents/guardians were contacted and an individual meeting scheduled. At that meeting, the aims of this research were presented, and the parents/guardians asked to give their consent, by signing the “Free and Informed Consent Form” (TCLE), if they agreed to let their child participate. For those who authorized it, an individual session with the child/adolescent was scheduled, in which the TISD was applied in an average time of 25 minutes. In total, 15 children/adolescents were evaluated.

Regarding the NG group, all data were collected at the participants’ school. A public school and a private school in the same city where the hospital was located were chosen. These data were collected as follows: (1) initially the research was presented to the teachers (preference was given to the Portuguese teachers), and if they agreed to participate, express authorization was requested through signing the TCLE; (2) those who agreed to participate completed a questionnaire that sought to investigate the inclusion criteria of the children in the research, i.e.: not meeting diagnostic criteria for DD (WHO, 2008); not having a complaint of possible neuropsychiatric or mood disorders or mental or genetic syndromes; not using psychotropic drugs.

Next, a meeting was convened with the parents/guardians of the children in whom all these criteria were met. At that meeting the research was presented and if the parents/guardians authorized it, they were asked to sign the TCLE. The parents/guardians also answered a questionnaire aiming to investigate the inclusion criteria of the children in the research, the same as those verified with the teachers. Following these procedures, it was found that all the children initially selected by the teachers could be included in the research.

The next and last step consisted of applying the TISD, with an average duration of 25 minutes, in an individual session. There was a total of 146 children. This step was performed during the child’s regular period of attendance at school or in the evening, having checked the best period with the principal to avoid interfering with the child’s routine activities.

Data analysis. The Statistical Package for Social Sciences 20.0 for Windows® (SPSS Inc, Chicago, IL, USA, 2008) program was used. Using descriptive statistic, data on frequency, average, standard deviation, minimum and maximum scores were obtained. Given the sample size and, consequently, lack of normal distribution, the types of inferential statistics analysis selected were all non-parametric. Levels of significance were: p < 0.05 (significant value), p < 0.01 (very significant value) and p < 0.001 (highly significant value). Effect size was also verified by means of Cohen’s d (d). The reference values for this type of analysis were: < 0.2 - 0.3 as a small effect; 0.4 - 0.7 as medium effect; > 0.8 large effect (Cohen, 1988Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.).

Ethical Considerations

All of the above procedures were authorized by the PUC-Campinas Research Ethics Committee (CAAE: 45679615.7.1001.5481).

Results

Table 2 shows the descriptive statistics (mean and standard deviation) as well as the comparison between the groups in the subtests and TISD total. For this comparison the Mann-Whitney test, complemented by Cohen’s d (d), was used.

Table 2
Descriptive statistics and comparison of performance in the subtests and TISD total between the groups of children with Developmental Dyslexia and those without learning difficulties

It can be seen that in all subtests and in TISD total the group with DD showed statistically significant poorer performance, obtaining a higher score in the test, confirming its discriminative capacity. Moreover, the magnitude of the effect indicated medium effects for Reading, Writing, Rapid Naming and for the total. Small effects were observed for Visual Attention, Short Term Memory, Calculus, Motor Skills and Phonological Awareness.

Discussion

The results of the study indicated that the group with DD showed poorer performance in all subtests and in the TISD total, with higher scores, even with this group having a slightly higher mean age than that of the NG. Thus, it confirmed the discriminative ability of the test, of existence of performance differences between the CG and NG groups, even with some of the subtests having small difference effects between the groups.

As the nomenclature itself and diagnostic criteria point out, DD is the specific disorder of reading, with the most evident effects being linked to this ability (APA, 2013American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-V (5th ed.). Washington, DC: Author.). The TISD reading subtest aims to assess this ability. The negative effects presented by the children with this disorder, ascertained from this investigation, were expected. Other research has shown similar results, so that reading letters (Ellis, 2014Ellis, A. W. (2014). Reading, writing and dyslexia: A cognitive analysis. New York, NY: Psychology Press.; Torppa, Poikkeus, Laakso, Eklund, & Lyytinen, 2006Torppa, M., Poikkeus, A. M., Laakso, M. L., Eklund, K., & Lyytinen, H. (2006). Predicting delayed letter knowledge development and its relation to grade 1 reading achievement among children with and without familial risk for dyslexia. Developmental Psychology, 42(6), 1128-1142. doi: 10.1037/0012-1649.42.6.1128
https://doi.org/10.1037/0012-1649.42.6.1...
; Ziegler, Perry, & Zorzi, 2014Ziegler, J. C., Perry, C., & Zorzi, M. (2014). Modelling reading development through phonological decoding and self-teaching: Implications for dyslexia. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 369(1634), 20120397. doi: 10.1098/rstb.2012.0397
https://doi.org/10.1098/rstb.2012.0397...
) and reading words are affected by the disorder (Capellini et al., 2007Capellini, S. A., Padula, N. A. M. R., Santos, L. C. A., Lourenceti, M. D., Carrenho, E. H., & Ribeiro, L. A. (2007). Desempenho em consciência fonológica, memória operacional, leitura e escrita na dislexia familial [Phonological awareness, working memory, reading and writing performances in familial dyslexia]. Pró-Fono, 19(4), 374-380. doi: 10.1590/S0104-56872007000400009
https://doi.org/10.1590/S0104-5687200700...
; Savill & Thierry, 2011Savill, N. J., & Thierry, G. (2011). Reading for sound with dyslexia: Evidence for early orthographic and late phonological integration deficits. Brain Research, 1385, 192-205. doi: 10.1016/j.brainres.2011.02.012
https://doi.org/10.1016/j.brainres.2011....
; Zoccolotti et al., 2013Zoccolotti, P., De Luca, M., Lami, L., Pizzoli, C., Pontillo, M., & Spinelli, D. (2013). Multiple stimulus presentation yields larger deficits in children with developmental dyslexia: A study with reading and RAN-type tasks. Child Neuropsychology, 19(6), 639-647. doi: 10.1080/09297049.2012.718325
https://doi.org/10.1080/09297049.2012.71...
), with greater negative effect found in reading pseudowords (Krafnick, Flowers, Napoliello, & Eden, 2011Krafnick, A. J., Flowers, D. L., Napoliello, E. M., & Eden, G. F. (2011). Gray matter volume changes following reading intervention in dyslexic children. Neuroimage, 57(3), 733-741. doi: 10.1016/j.neuroimage.2010.10.062
https://doi.org/10.1016/j.neuroimage.201...
; Traficante, Marcolini, Luci, Zoccolotti, & Burani, 2011Traficante, D., Marcolini, S., Luci, A., Zoccolotti, P., & Burani, C. (2011). How do roots and suffixes influence reading of pseudowords: A study of young Italian readers with and without dyslexia. Language and Cognitive Processes, 26(4-6), 777-793. doi: 10.1080/01690965.2010.496553
https://doi.org/10.1080/01690965.2010.49...
).

Negative effects on writing are also characteristic of this disorder, with errors very similar to those of reading (APA, 2013American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-V (5th ed.). Washington, DC: Author., Ellis, 2014Ellis, A. W. (2014). Reading, writing and dyslexia: A cognitive analysis. New York, NY: Psychology Press.). Thus, the results found here in this subtest were expected, with poorer performance of the diagnosed group. The literature indicates negative effects on writing letters (Brooks, Berninger, & Abbott, 2011Brooks, A. D., Berninger, V. W., & Abbott, R. D. (2011). Letter naming and letter writing reversals in children with dyslexia: Momentary inefficiency in the phonological and orthographic loops of working memory. Developmental Neuropsychology, 36(7), 847-868. doi: 10.1080/87565641.2011.606401
https://doi.org/10.1080/87565641.2011.60...
; Torppa et al., 2006Torppa, M., Poikkeus, A. M., Laakso, M. L., Eklund, K., & Lyytinen, H. (2006). Predicting delayed letter knowledge development and its relation to grade 1 reading achievement among children with and without familial risk for dyslexia. Developmental Psychology, 42(6), 1128-1142. doi: 10.1037/0012-1649.42.6.1128
https://doi.org/10.1037/0012-1649.42.6.1...
; Zorzi et al., 2012Zorzi, M., Barbiero, C., Facoetti, A., Lonciari, I., Carrozzi, M., Montico, M., ... Ziegler, J. C. (2012). Extra-large letter spacing improves reading in dyslexia. Proceedings of the National Academy of Sciences of the United States of America, 109(28), 11455-11459. doi: 10.1073/pnas.1205566109
https://doi.org/10.1073/pnas.1205566109...
), words (Kast, Bezzola, Jäncke, & Meyer, 2011Kast, M., Bezzola, L., Jäncke, L., & Meyer, M. (2011). Multi-and unisensory decoding of words and nonwords result in differential brain responses in dyslexic and nondyslexic adults. Brain and Language, 119(3), 136-148. doi: 10.1016/j.bandl.2011.04.002
https://doi.org/10.1016/j.bandl.2011.04....
; Lovio, Näätänen, & Kujala, 2010Lovio, R., Näätänen, R., & Kujala, T. (2010). Abnormal pattern of cortical speech feature discrimination in 6-year-old children at risk for dyslexia. Brain Research, 1335, 53-62. doi: 10.1016/j.brainres.2010.03.097
https://doi.org/10.1016/j.brainres.2010....
; Salgado et al., 2006Salgado, C. A., Pinheiro, A., Sassi, A. G., Tabaquim, M. L. M., Ciasca, S. M., & Capellini, S. A. (2006). Avaliação fonoaudiológica e neuropsicológica na dislexia do desenvolvimento do tipo mista: Relato de caso [Speech therapy and neuropsychological assessment in developmental dyslexia of mixed type: Case report]. Salusvita, 25(1), 91-103. Retrieved from https://secure.usc.br/static/biblioteca/salusvita/salusvita_v25_n1_2006_art_07.pdf
https://secure.usc.br/static/biblioteca/...
; Zorzi & Ciasca, 2009Zorzi, J. L., & Ciasca, S. M. (2009). Análise de erros ortográficos em diferentes problemas de aprendizagem. Revista CEFAC, 11(3), 406-416. doi: 10.1590/S1516-18462009000300007
https://doi.org/10.1590/S1516-1846200900...
) and pseudowords (Lindgrén & Laine, 2011Lindgrén, S. A., & Laine, M. (2011). Cognitive-linguistic performances of multilingual university students suspected of dyslexia. Dyslexia, 17(2), 184-200. doi: 10.1002/dys.422
https://doi.org/10.1002/dys.422...
; Ramus & Szenkovits, 2008Ramus, F., & Szenkovits, G. (2008). What phonological deficit? The Quarterly Journal of Experimental Psychology, 61(1), 129-141. doi: 10.1080/17470210701508822
https://doi.org/10.1080/1747021070150882...
). The writing subtest consisted of all these skills.

Another school ability in which negative effects of DD are described is mathematics (Evans, Flowers, Napoliello, Olulade, & Eden, 2014Evans, T. M., Flowers, D. L., Napoliello, E. M., Olulade, O. A., & Eden, G. F. (2014). The functional anatomy of single-digit arithmetic in children with developmental dyslexia. NeuroImage, 101, 644-652. doi: 10.1016/j.neuroimage.2014.07.028
https://doi.org/10.1016/j.neuroimage.201...
). Specifically, in TISD, the Calculation subtest consisted only of problems to be solved mentally. The literature indicates the disadvantages individuals with DD face in this type of task, as found here, probably due to the fact that these deficits are accompanied by impairment of reading and the cognitive processes supporting it, such as phonological processing and executive functions (Simmons & Singleton, 2006Simmons, F. R., & Singleton, C. (2006). The mental and written arithmetic abilities of adults with dyslexia. Dyslexia, 12(2), 96-114. doi: 10.1002/dys.312
https://doi.org/10.1002/dys.312...
, 2008Simmons, F. R., & Singleton, C. (2008). Do weak phonological representations impact on arithmetic development? A review of research into arithmetic and dyslexia. Dyslexia, 14(2), 77-94. doi: 10.1002/dys.341
https://doi.org/10.1002/dys.341...
, 2009Simmons, F. R., & Singleton, C. (2009). The mathematical strengths and weaknesses of children with dyslexia. Journal of Research in Special Educational Needs, 9(3), 154-163. doi: 10.1111/j.1471-3802.2009.01128.x
https://doi.org/10.1111/j.1471-3802.2009...
). Silva, Moura, Wood and Hasse (2015Silva, J. B. L., Moura, R. J., Wood, G., & Haase, V. G. (2015). Processamento fonológico e desempenho em aritmética: Uma revisão da relevância para as dificuldades de aprendizagem [Phonological processing and mathematic performance: A review of the relevance to learning disabilities]. Temas em Psicologia, 23(1), 157-173. doi: 10.9788/TP2015.1-11
https://doi.org/10.9788/TP2015.1-11...
) have described that phonological processing, the main deficit in DD, can affect symbolic aspects of mathematics, such as automation of arithmetic facts, problem solving and numerical transcoding. In a national study, Caldonazzo, Salgado, Capellini and Ciasca (2006Caldonazzo, A., Salgado, C. A., Capellini, S. A., & Ciasca, S. M. (2006). Desempenho na resolução de problemas envolvendo o conceito aditivo em sujeitos com dislexia do desenvolvimento [Performance in the problems resolution involving the addictive concept in subject with developmental dyslexia]. Revista Psicopedagogia, 23(71), 116-123. Retrieved from http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0103-84862006000200005
http://pepsic.bvsalud.org/scielo.php?scr...
) found that children with DD tended to perform well in calculations which did not involve the recognition/reading of algorithms and reading the problem itself. Thus, during the proposed inclusion of this subtest in the TISD it was expected that children with DD would probably present good performance in this subtest, but, seen empirically, the data showed the opposite. Thus, such ability was impaired in the diagnosed children, irrespective of how the problems were presented.

In relation to the Visual Attention subtest, the literature empirically indicates data such as those found here, indicating DD impairments in this ability. Some authors argue that the disorder itself could be explained mainly by this neuropsychological deficit (Facoetti & Turatto, 2000Facoetti, A., & Turatto, M. (2000). Asymmetrical visual fields distribution of attention in dyslexic children: A neuropsychological study. Neuroscience Letters, 290(3), 216-218. doi: 10.1016/S0304-3940(00)01354-9
https://doi.org/10.1016/S0304-3940(00)01...
; Facoetti, Turatto, Lorusso, & Mascetti, 2001Facoetti, A., Turatto, M., Lorusso, M. L., & Mascetti, G. G. (2001). Orienting of visual attention in dyslexia: Evidence for asymmetric hemispheric control of attention. Experimental Brain Research, 138(1), 46-53. doi: 10.1007/s002210100700
https://doi.org/10.1007/s002210100700...
; Franceschini, Gori, Ruffino, Pedrolli, & Facoetti, 2012Franceschini, S., Gori, S., Ruffino, M., Pedrolli, K., & Facoetti, A. (2012). A causal link between visual spatial attention and reading acquisition. Current Biology, 22(9), 814-819. doi: 10.1016/j.cub.2012.03.013
https://doi.org/10.1016/j.cub.2012.03.01...
). The proposed task for TISD was based on verbal skills and, for this reason, the stimuli used were letters. As verified in the literature, the performance of individuals with DD is more affected in attention instruments that use verbal stimuli (Lima, Salgado-Azoni, & Ciasca, 2013Lima, R. F., Salgado-Azoni, C. A., & Ciasca, S. M. (2013). Atenção e funções executivas em crianças com dislexia do desenvolvimento [Attention and executive functions in children with developmental dyslexia]. Psicologia em Pesquisa, 7(2), 208-219. doi: 10.5327/Z1982-1247201300020009
https://doi.org/10.5327/Z1982-1247201300...
; Lima, Travaini, Salgado-Azoni, & Ciasca, 2012Lima, R. F., Travaini, P. P., Salgado-Azoni, C. A., & Ciasca, S. M. (2012). Atención sostenida visual y funciones ejecutivas en niños con dislexia de desarrollo [Visual sustained attention and executive functions in children with developmental dyslexia]. Anales de Psicología, 28(1), 66-70. Retrieved from http://www.redalyc.org/articulo.oa?id=16723161008
http://www.redalyc.org/articulo.oa?id=16...
). Ziegler, Pech-Georgel, Dufau and Grainger (2010Ziegler, J. C., Pech-Georgel, C., Dufau, S., & Grainger, J. (2010). Rapid processing of letters, digits and symbols: What purely visual-attentional deficit in developmental dyslexia? Developmental Science, 13(4), F8-F14. doi: 10.1111/j.1467-7687.2010.00983.x
https://doi.org/10.1111/j.1467-7687.2010...
) also showed that there would also be significant deficits in digits, in addition to letters, but not in symbols. According to these authors, these findings would further confirm negative effects on verbal skills of this disorder.

Regarding the impairment of GC in the Motor Skills subtest, the literature indicates similar results. The theory formulated by Nicolson and Fawcett (2011Nicolson, R. I., & Fawcett, A. J. (2011). Dyslexia, dysgraphia, procedural learning and the cerebellum. Cortex, 47(1), 117-127. doi: 10.1016/j.cortex.2009.08.016
https://doi.org/10.1016/j.cortex.2009.08...
) proposes that cerebellar dysfunctions are responsible for DD and that such a condition would be accompanied by deficits in motor skills, especially fine motor skills. In an empirical study that used a similar instrument to TISD to evaluate such abilities, performed by Santos and Jorge (2007Santos, A. A. A., & Jorge, L. M. (2007). Teste de Bender com disléxicos: Comparação de dois sistemas de pontuação. Psico-USF, 12(1), 13-21. doi: 10.1590/S1413-82712007000100003
https://doi.org/10.1590/S1413-8271200700...
), below-expected performance was found in children and adolescents with DD. Okuda, Lourencetti, Santos, Padula and Capellini (2011Okuda, P. M. M., Lourencetti, M. D., Santos, L. C. A., Padula, N. A. M. R., & Capellini, S. A. (2011). Coordenação motora fina de escolares com dislexia e transtorno do déficit de atenção e hiperatividade [Fine motor coordination of students with dyslexia and attention deficit disorder with hiperactivity]. Revista CEFAC, 13(5), 876-885. doi: 10.1590/S1516-18462011005000048
https://doi.org/10.1590/S1516-1846201100...
) also found deficits in fine motor coordination in schoolchildren with DD, specifically in dexterity. Other studies have also pointed out, in general, such motor deficit in the disorder (Brookes, Tinkler, Nicolson, & Fawcett, 2010Brookes, R. L., Tinkler, S., Nicolson, R. I., & Fawcett, A. J. (2010). Striking the right balance: Motor difficulties in children and adults with dyslexia. Dyslexia, 16(4), 358-373. doi: 10.1002/dys.420
https://doi.org/10.1002/dys.420...
; Danelli et al., 2013Danelli, L., Berlingeri, M., Bottini, G., Ferri, F., Vacchi, L., Sberna, M., & Paulesu, E. (2013). Neural intersections of the phonological, visual magnocellular and motor/cerebellar systems in normal readers: Implications for imaging studies on dyslexia. Human Brain Mapping, 34(10), 2669-2687. doi: 10.1002/hbm.22098
https://doi.org/10.1002/hbm.22098...
; Gabay, Schiff, & Vakil, 2012Gabay, Y., Schiff, R., & Vakil, E. (2012). Dissociation between the procedural learning of letter names and motor sequences in developmental dyslexia. Neuropsychologia, 50(10), 2435-2441. doi: 10.1016/j.neuropsychologia.2012.06.014
https://doi.org/10.1016/j.neuropsycholog...
; Stoodley, Harrison, & Stein, 2006Stoodley, C. J., Harrison, E. P. D., & Stein, J. F. (2006). Implicit motor learning deficits in dyslexic adults. Neuropsychologia, 44(5), 795-798. doi: 10.1016/j.neuropsychologia.2005.07.009
https://doi.org/10.1016/j.neuropsycholog...
; Yang & Hong-Yan, 2011Yang, Y., & Hong-Yan, B. (2011). Unilateral implicit motor learning deficit in developmental dyslexia. International Journal of Psychology, 46(1), 1-8. doi: 10.1080/00207594.2010.509800
https://doi.org/10.1080/00207594.2010.50...
).

Regarding the Phonological Awareness subtest, poor performance in the CG was also expected. The most accepted theory for DD is that of a deficit in phonological processing of information (Snowling & Hulme, 2012Snowling, M. J., & Hulme, C. (2012). Annual research review: The nature and classification of reading disorders: A commentary on proposals for DSM-5. Journal of Child Psychology and Psychiatry, 53(5), 593-607. doi: 10.1111/j.1469-7610.2011.02495.x
https://doi.org/10.1111/j.1469-7610.2011...
). Thus, phonological awareness would be one of the components of such processing, involving, basically, conscious access to phonological representations with the temporary maintenance and manipulation of these representations (Ramus & Szenkovits, 2008Ramus, F., & Szenkovits, G. (2008). What phonological deficit? The Quarterly Journal of Experimental Psychology, 61(1), 129-141. doi: 10.1080/17470210701508822
https://doi.org/10.1080/1747021070150882...
). In TISD, this ability was evaluated through identification and production of rhyme, a procedure also used in other studies, which indicated the sensitivity of these tests in identifying the disorder (Goswami, 2011Goswami, U. (2011). A temporal sampling framework for developmental dyslexia. Trends in Cognitive Sciences, 15(1), 3-10. doi: 10.1016/j.tics.2010.10.001
https://doi.org/10.1016/j.tics.2010.10.0...
; Kovelman et al., 2012Kovelman, I., Norton, E. S., Christodoulou, J. A., Gaab, N., Lieberman, D. A., Triantafyllou, C., Gabrieli, J. D. (2012). Brain basis of phonological awareness for spoken language in children and its disruption in dyslexia. Cerebral Cortex, 22(4), 754-764. doi: 10.1093/cercor/bhr094
https://doi.org/10.1093/cercor/bhr094...
; Pugh et al., 2000Pugh, K. R., Mencl, W. E., Shaywitz, B. A., Shaywitz, S. E., Fulbright, R. K., Constable, R. T., Gore, J. C. (2000). The angular gyrus in developmental dyslexia: Task-specific differences in functional connectivity within posterior cortex. Psychological Science, 11(1), 51-56. doi: 10.1111/1467-9280.00214
https://doi.org/10.1111/1467-9280.00214...
Ziegler & Goswami, 2005Ziegler, J. C., & Goswami, U. (2005). Reading acquisition, developmental dyslexia, and skilled reading across languages: A psycholinguistic grain size theory. Psychological Bulletin, 131(1), 3-29. doi: 10.1037/0033-2909.131.1.3
https://doi.org/10.1037/0033-2909.131.1....
).

In the Rapid Naming subtest, CG performance was expected to be poor, which was confirmed in the sample studied. The rapid naming task is used to evaluate lexical access (in the form of access to phonological representations), which is also a component of phonological processing (Shaywitz & Shaywitz, 2005Shaywitz, S. E., & Shaywitz, B. A. (2005). Dyslexia (specific reading disability). Biological Psychiatry, 57(11), 1301-1309. doi: 10.1016/j.biopsych.2005.01.043
https://doi.org/10.1016/j.biopsych.2005....
). The data found reinforce the work of different researchers, whose studies have evidenced shortcomings rapid naming measures in DD (Andrade, Prado, & Capellini, 2011Andrade, O. V. C. A., Prado, P. S. T., & Capellini, S. A. (2011). Desenvolvimento de ferramentas pedagógicas para identificação de escolares de risco para a dislexia [Developing pedagogical tools for early identification of students at risk for dyslexia]. Revista Psicopedagogia, 28(85), 14-28. Retrieved from http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S0103-84862011000100003
http://pepsic.bvsalud.org/scielo.php?scr...
; Jones, Ashby, & Branigan, 2013Jones, M. W., Ashby, J., & Branigan, H. P. (2013). Dyslexia and fluency: Parafoveal and foveal influences on rapid automatized naming. Journal of Experimental Psychology: Human Perception and Performance, 39(2), 554-567. doi: 10.1037/a0029710
https://doi.org/10.1037/a0029710...
; Jones, Branigan, & Kelly, 2009Jones, M. W., Branigan, H. P., & Kelly, M. L. (2009). Dyslexic and nondyslexic reading fluency: Rapid automatized naming and the importance of continuous lists. Psychonomic Bulletin & Review, 16(3), 567-572. doi: 10.3758%2FPBR.16.3.567
https://doi.org/10.3758%2FPBR.16.3.567...
; Norton & Wolf, 2012Norton, E. S., & Wolf, M. (2012). Rapid automatized naming (RAN) and reading fluency: Implications for understanding and treatment of reading disabilities. Annual Review of Psychology, 63, 427-452. doi: 10.1146/annurev-psych-120710-100431
https://doi.org/10.1146/annurev-psych-12...
). The double-deficit theory proposed by Denckla and Rudel (1976Denckla, M. B., & Rudel, R. G. (1976). Rapid ‘automatized’ naming (RAN): Dyslexia differentiated from other learning disabilities. Neuropsychologia, 14(4), 471-479. doi: 10.1016/0028-3932(76)90075-0
https://doi.org/10.1016/0028-3932(76)900...
) has been used to explain specific problems in retrieving phonological information from long-term memory, an essential component for efficient reading performance.

CG impairment was also observed in the Short Term Memory subtests. This TISD subtest focused specifically on evaluating short-term memory through verbal content. The evaluation items were presented orally (digits and pseudowords) and should also be answered in this way. This type of memory is responsible for the brief storage of verbal material and is considered one of the components of phonological operational memory. Phonological operational memory (also called “working memory phonological loop”) is also one of the components of phonological processing (Ramus & Szenkovits, 2008Ramus, F., & Szenkovits, G. (2008). What phonological deficit? The Quarterly Journal of Experimental Psychology, 61(1), 129-141. doi: 10.1080/17470210701508822
https://doi.org/10.1080/1747021070150882...
). In all cases, negative effects on all of its components, including short-term auditory memory, are frequently observed in DD (Capovilla et al., 2001Capovilla, A. G. S., Smythe, I., Capovilla, F. C., & Everatt, J. (2001). Adaptação brasileira do International Dyslexia Test: Perfil cognitivo de crianças com escrita pobre [Brazilian adaptation of the international dyslexia test: Cognitive profile of children with poor writing]. Temas sobre Desenvolvimento, 10(57), 30-37.; Martinez Perez, Majerus, Mahot, & Poncelet, 2012Martinez Perez, T. M., Majerus, S., Mahot, A., & Poncelet, M. (2012). Evidence for a specific impairment of serial order short-term memory in dyslexic children. Dyslexia, 18(2), 94-109. doi: 10.1002/dys.1438
https://doi.org/10.1002/dys.1438...
; Salles & Parente, 2002Salles, J. F., & Parente, M. A. M. P. (2002). Processos cognitivos na leitura de palavras em crianças: Relações com compreensão e tempo de leitura [Cognitive processes involved in childrens word reading: Relations with reading comprehension and reading time]. Psicologia: Reflexão e Crítica, 15(2), 321-331. doi: 10.1590/S0102-79722002000200010
https://doi.org/10.1590/S0102-7972200200...
; Trecy, Steve, & Martine, 2013Trecy, M. P., Steve, M., & Martine, P. (2013). Impaired short-term memory for order in adults with dyslexia. Research in Developmental Disabilities, 34(7), 2211-2223. doi: 10.1016/j.ridd.2013.04.005
https://doi.org/10.1016/j.ridd.2013.04.0...
). Again, significant differences were found between CG and NG in this ability, proving the effectiveness of the subtest in differentiating them.

Finally, in relation to the TISD total score there were significant differences between the group with DD and that without reading and writing difficulties, with worse negative effects on the former. Considering the reported negative effects noted in all skills/subtests of the instrument in the DD group, it was expected that such difference would also be observed in the total score of the test, which was effectively verified. The results obtained in the study suggest that the test was able to differentiate groups, indicating evidence of validity based on relations with external variables, more specifically, criterion validity when discriminating the diagnostic group (Kline, 2015Kline, P. (2015). A handbook of test construction (psychology revivals): Introduction to psychometric design. New York, NY: Routledge.). It should be noted that some subtests such as Calculus, Motor Skills and Phonological Awareness had little effect in relation to the magnitude of the differences between the groups, so it is hoped that in future studies involving a greater number of subjects with DD and other evidence of validity, such subtests will be better investigated. Moreover, it is hoped that in future studies such discriminative capacity will be verified for other neurodevelopmental disorders, in order to obtain greater clinical applicability in the use of the instrument.

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  • 1
    Support: Article derived from the doctoral thesis of the first author under the supervision of the second, defended in 2016, in the Graduate Program in Psychology at the Pontifícia Universidade Católica de Campinas. Financial support from the National Council for Scientific and Technological Development (CNPq), case No. 140281/2014-2.
  • 4
    Ricardo Franco de Lima is a Professor at the Universidade São Francisco at Bragança Paulista.
  • 5
    Sylvia Maria Ciasca is a Professor at the Faculdade de Ciências Médicas at Campinas of the Universidade Estadual de Campinas.

Publication Dates

  • Publication in this collection
    17 Dec 2018
  • Date of issue
    2018

History

  • Received
    28 June 2016
  • Reviewed
    03 Jan 2017
  • Accepted
    02 May 2018
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