Diagnosis of developmental learning and attention disorders in adults: A review of clinical modalities

Event-related potential and lexical decision task in dyslexic adults: Lexical and lateralization effects

Developmental dyslexia is a specific learning disorder that presents cognitive and neurobiological impairments related to different patterns of brain activation throughout development, continuing in adulthood. Lexical decision tasks, together with electroencephalography (EEG) measures that have great temporal precision, allow the capture of cognitive processes during the task, and can assist in the understanding of altered brain activation processes in adult dyslexics. High-density EEG allows the use of temporal analyses through event-related potentials (ERPs). The aim of this study was to compare and measure the pattern of ERPs in adults with developmental dyslexia and good readers, and to characterize and compare reading patterns between groups. Twenty university adults diagnosed with developmental dyslexia and 23 healthy adult readers paired with dyslexics participated in the study. The groups were assessed in tests of intelligence, phonological awareness, reading, and writing, as well as through the lexical decision test (LDT). During LDT, ERPs were recorded using a 128-channel EEG device. The ERPs P100 occipital, N170 occipito-temporal, N400 centro-parietal, and LPC centro-parietal were analyzed. The results showed a different cognitive profile between the groups in the reading, phonological awareness, and writing tests but not in the intelligence test. In addition, the brain activation pattern of the ERPs was different between the groups in terms of hemispheric lateralization, with higher amplitude of N170 in the dyslexia group in the right hemisphere and opposite pattern in the control group and specificities in relation to the items of the LDT, as the N400 were more negative in the Dyslexia group for words, while in the control group, this ERP was more pronounced in the pseudowords. These results are important for understanding different brain patterns in developmental dyslexia and can better guide future interventions according to the changes found in the profile.

Is It Just Face Blindness? Exploring Developmental Comorbidity in Individuals with Self-Reported Developmental Prosopagnosia

Developmental prosopagnosia (DP)—or ‘face blindness’—refers to life-long problems with facial recognition in the absence of brain injury. We know that neurodevelopmental disorders tend to co-occur, and this study aims to explore if individuals with self-reported DP also report indications of other neurodevelopmental disorders, deficits, or conditions (developmental comorbidity). In total, 115 individuals with self-reported DP participated in this online cross-sectional survey. Face recognition impairment was measured with a validated self-report instrument. Indications of difficulties with navigation, math, reading, or spelling were measured with a tailored questionnaire using items from published sources. Additional diagnoses were measured with direct questions. We also included open-ended questions about cognitive strengths and difficulties. Results: Overall, 57% reported at minimum one developmental comorbidity of interest, with most reflecting specific cognitive impairment (e.g., in memory or object recognition) rather than diagnostic categories (e.g., ADHD, dyslexia). Interestingly, many participants reported cognitive skills or strengths within the same domains that others reported impairment, indicating a diverse pattern of cognitive strengths and difficulties in this sample. The frequency and diversity of self-reported developmental comorbidity suggests that face recognition could be important to consider in future investigations of neurodevelopmental comorbidity patterns.

Diagnosing adults with dyslexia: Psychologists' experiences and practices

Previous research has investigated how psychologists identify dyslexia in school-aged children. However, it is presently unclear how psychologists diagnose dyslexia in adults. This study aimed to explore psychologists' understandings and experiences in how they assess adults for dyslexia. Nine psychologists in Australia were recruited from professional associations and interviewed using a semi-structured schedule. After member checks, transcripts were analysed using reflexive thematic analysis. The results suggested that participants' assessment practices with adults were similar to those used with children. However, participants were not confident in assessing adults due to a lack of an empirical base and training, and appropriately normed tools. Moreover, participants relied on their clinical judgment to help overcome barriers unique to the assessment of adults including obtaining an accurate developmental history and determining the relevancy of academic intervention for a formal diagnosis. Participants recommended (better) training and accessible research about how to efficaciously diagnose adults with dyslexia. The robustness of current diagnostic tools for equitably identifying adults with dyslexia was questioned by some participants. There is a need for national guidelines in Australia to support psychologists in identifying adults with dyslexia. International research and guidelines have an important role to play in informing this process.

Examining the selection of university courses in young adults with learning disabilities

The literature contains a great deal of research on Specific Learning Disorders (SpLDs). However, almost all of the studies related to SpLDs deal with the difficulties that said disorders cause during childhood or adolescence. An interest in adults with SpLDs is only recent, especially in university students like those in this study. In Italy, research on SpLDs in higher education is rather limited. This study aims to rectify this lack of data by making a brief analysis of the data on SpLDs prevalence in higher education and of the courses chosen by university students with SpLDs. Our sample consisted of 585 students with SpLDs enrolled at 19 public universities that communicated the number of students who contacted their offices of service for students with SpLDs. The prevalence of students with SpLDs in the higher education populations we sample had a mean of 0.13% (SD = 0.11) and ranged from 0.03% to 0.48%. The data showed that the higher education faculties with the highest number of reported SpLDs students in our sample were Statistics, Agriculture, Veterinary Science, Education, and Architecture. It is important to analyse the trend in university enrolment of student with SpLDs to protect the right to education for people with SpLDs.

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

Like virtually all age-related chronic diseases, late-onset Alzheimer's disease (AD) develops over an extended preclinical period and is associated with modifiable lifestyle and environmental factors. We hypothesize that multimodal interventions that address many risk factors simultaneously and are individually tailored to patients may help reduce AD risk. We describe a novel clinical methodology used to evaluate and treat patients at two Alzheimer's Prevention Clinics. The framework applies evidence-based principles of clinical precision medicine to tailor individualized recommendations, follow patients longitudinally to continually refine the interventions, and evaluate N-of-1 effectiveness (trial registered at ClinicalTrials.gov NCT03687710). Prior preliminary results suggest that the clinical practice of AD risk reduction is feasible, with measurable improvements in cognition and biomarkers of AD risk. We propose using these early findings as a foundation to evaluate the comparative effectiveness of personalized risk management within an international network of clinician researchers in a cohort study possibly leading to a randomized controlled trial.

Identifying dyslexia risk for sport-related concussion management: Sensitivity and specificity of self-report and rapid naming

BACKGROUND

Dyslexia is the most common type of learning disability and studies have shown that student-athletes with learning disabilities sustain more concussions than their non-affected peers. However, current methods of dyslexia identification in college students are potentially invalid because they rely on students to self-report formal dyslexia diagnoses.

METHODS

To test the accuracy of self-report against two alternative methods of dyslexia screening, 94 college students completed three dyslexia symptom inventories, two rapid naming (RAN) tasks, and a standard word reading measure.

RESULTS

Reliability was acceptable for screening purposes on the inventories (α =.70, -.72), and excellent for RAN (α = .91, -.94). Specificity was acceptable (82.5%), but sensitivity was low (14.3%) when students self-reported suspected diagnoses of reading impairment. Sensitivity and specificity were higher for the digit RAN task (71 and 98%, respectively) compared to the letter RAN task (57 and 90%). Sensitivity (92.7%) and specificity (92.5%) were optimal when a cut-score of ≥27 seconds was used. A binary logistic regression showed digit RAN alone significantly predicted whether students were classified as typical or inefficient readers, p< .001, whereas the most reliable dyslexia inventory alone did not, p=.284. Including inventories along with RAN provided no additional predictive value.

CONCLUSION

Self-report inventories missed many cases of inefficient word reading. The digit RAN task classified 93.6% of the cases correctly compared to 72.3% for self-report inventory. Thus, we recommend that neuropsychologists working with college concussion management programs add to their baseline screening protocols the digit RAN task, which can be completed in less than one minute.