Archives: Treatment

Dyslexia Intervention

CDBC/BCAAN Educational bite: Originally emailed March 13, 2024

Targeted reading interventions improve word reading and spelling: A recent meta-analysis of 53 reading interventions targeting foundational skills for children at risk or with dyslexia show a significant, positive effect on norm-referenced reading outcomes. Dosage (higher=slightly larger effect sizes) and outcome domain (spelling and word reading were more impacted than reading comprehension) were important moderators (Hall et al., 2023). “Mean effects of interventions delivered earlier (in Grades K-2) were not statistically significantly larger than effects of interventions delivered later (in Grades 3–5). Descriptively speaking, though, studies with students in Grades 3–5 were associated with smaller effects (g = 0.16) than studies with students in Grades K-2 (g = 0.36).”

Phonological awareness can be directly taught through instruction: As suggested in the National Panel on Reading (2020), phonological and phonemic awareness instruction are important components of preventing and treating dyslexia. This intervention continues to be well supported as being able to be trained through intervention (Rehfeld et al., 2022). Phonological awareness training must be paired with high quality targeted reading intervention.

Music training may play a role in helping those with dyslexia: A prospective study published in PLoS One (Flaugnacco et al., 2015) suggested that music training can improve phonological awareness and reading in children with dyslexia, presumably due to an underlying poor temporal perception which is improved through training.

Treatments without research support

Neurofeedback: There is not sufficient research to support EEG neurofeedback as an intervention for reading (Othman et al., 2020).

Vision therapy: According to a joint statement which included the American Academy of Pediatrics, section on Ophthalmology “Convergence insufficiency and poor accommodation, both of which are uncommon in children, can interfere with the physical act of reading but not with decoding. Thus, treatment of these disorders can make reading more comfortable and may allow reading for longer periods of time but does not directly improve decoding or comprehension.” Overall, while vision therapy can help individuals with convergence insufficiency, it is not accepted as an appropriate treatment to improve reading, either directly or indirectly (initially published in 2009, and re-affirmed in 2014).

References

American Academy of Pediatrics, Section on Ophthalmology, Council on Children with Disabilities, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, & American Association of Certified Orthoptists (2009). Joint statement–Learning disabilities, dyslexia, and vision. Pediatrics, 124(2), 837–844. https://doi.org/10.1542/peds.2009-1445

Flaugnacco, E., Lopez, L., Terribili, C., Montico, M., Zoia, S., & Schön, D. (2015). Music Training Increases Phonological Awareness and Reading Skills in Developmental Dyslexia: A Randomized Control Trial. PloS one, 10(9), e0138715. https://doi.org/10.1371/journal.pone.0138715

Hall, C., Dahl‐Leonard, K., Cho, E., Solari, E. J., Capin, P., Conner, C. L., Henry, A. R., Cook, L., Hayes, L., Vargas, I., Richmond, C. L., & Kehoe, K. F. (2023). Forty years of reading intervention research for elementary students with or at risk for dyslexia: A systematic review and Meta‐Analysis. Reading Research Quarterly, 58(2), 285-312. https://doi.org/10.1002/rrq.477

Othman, E. S., Faye, I., Sundaram Muthuvalu, M., & Naufal Mohamad Saad, M. (2020). EEG neurofeedback for dyslexia treatment: Limitations and future directions. Journal of Physics. Conference Series, 1497(1), 12028. https://doi.org/10.1088/1742-6596/1497/1/012028

National Reading Panel (U.S.) & National Institute of Child Health and Human Development (U.S.). (2000). Report of the National Reading Panel: Teaching children to read : an evidence-based assessment of the scientific research literature on reading and its implications for reading instruction, https://www.nichd.nih.gov/sites/default/files/publications/pubs/nrp/Documents/report.pdf

Vimont, C. (2017). Vision Training Not Proven to Make Vision Sharper, American Academy of Ophthalmology, https://www.aao.org/eye-health/tips-prevention/vision-training-not-proven-to-make-vision-sharper

Executive functioning intervention – Research review

CDBC/BCAAN Research Bite: Originally emailed March 8, 2024

Adele Diamond’s group published a systematic mega-review of 179 studies up to 2015 (Diamond & Ling 2019) on intervention to improve EFs. Importantly, this paper required each study to have at least one behavioural measure, include a measure of generalization, include a control group, and not be purely correlational.

Mindful movement practices (e.g., taekwondo & t’ai chi) showed the strongest results for improving EFs. Mindful movement exercises did better than more sedentary mindful practices. 30-40 minute sessions were more helpful than those less than 30 minutes. School-based programs such as Promoting Alternative Thinking Strategies, the Chicago School Readiness Project, and Tools of the Mind came in second, and were particularly good for improving inhibitory control. Both types of approaches showed better results than computerized cognitive training (e.g., CogMed).

Some key principles the paper summarized:

  1. EF can be improved.
  2. Generalization to untrained tasks usually occurs for similar tasks, but rarely improves on unpracticed tasks. Broader transfer effects happen with practice of a wider range of skills.
  3. EF training must include continued challenge, where the task adapts to keep challenging the person.
  4. Effects can last over time, but generally grow smaller (use it or lose it).
  5. Those with more EF challenges benefit the most from intervention.
  6. More training is generally better, with the exception of aerobic exercises with no evidence of greater EF benefits from longer programs.
  7. For the most part, length of the sessions matters, with sessions > 30 minutes showing better results than those less than 30 minutes.
  8. Spaced (distributed) practice produces better long-term outcomes than massed practice.
  9. Benefits are mostly clearly seen on complex, multi-component EF tasks

In addition, there seems to be strong evidence for the role of physical activity in improving EF in individuals with ADHD. A PLoS One meta-analysis (Song et al., 2023)   found a significant impact of physical interventions on inhibitory control, working memory and cognitive flexibility in children and teens with ADHD. While there was a benefit to all kinds of physical activity, results were in line with the first paper above in that moderate exercise and those which require adaptive/flexible skills, and which endure over time show the most promise.

UPDATE: ‘debate and request for further dialogue’ for the research from a group of researchers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969305/

References

Diamond, A. & Ling, D. S. (2019). Review of the evidence on, and fundamental questions about, efforts to improve executive functions, including working memory. In J. Novick, M.F. Bunting, M.R. Dougherty & R. W. Engle (Eds.), Cognitive and working memory training: Perspectives from psychology, neuroscience, and human development, (pp.143-431). New York, NY: Oxford University Press. (pdf)

Song, Y., Fan, B., Wang, C., & Yu, H. (2023). Meta-analysis of the effects of physical activity on executive function in children and adolescents with attention deficit hyperactivity disorder. PloS one, 18(8), e0289732. https://doi.org/10.1371/journal.pone.0289732