Advancing Dyslexia Assessment in Children through Computerized Testing
Summary
The Multimedia Battery for Assessment of General-Domain and Specific-Domain Skills in Reading is a reliable and valid multimedia battery designed to assess cognitive and basic reading skills. It enables the generation of a comprehensive cognitive and reading performance profile, which is particularly beneficial for children with dyslexia.
Abstract
The acquisition of reading skills is an intricate process that demands the cultivation of various domain-general and domain-specific abilities. Consequently, it is unsurprising that many children grapple with maintaining proficiency at the grade level, particularly when confronted with challenges spanning multiple abilities across both domains, as observed in individuals with reading difficulties. Strikingly, despite reading difficulties being among the most prevalent neurodevelopmental disorders affecting school-aged children, the majority of available diagnostic tools lack a comprehensive framework for assessing the full spectrum of cognitive skills linked to dyslexia, with minimal computerized options. Notably, there are currently limited tools with these features available for Spanish-speaking children. The aim of this study was to delineate the protocol for diagnosing Spanish-speaking children with reading difficulties using the Sicole-R multimedia battery. This tool for elementary grades focuses on evaluating cognitive skills that are associated with dyslexia as prescribed by the scientific literature. Specifically, it concentrates on assessing a range of cognitive abilities that studies have demonstrated to be linked to dyslexia. This focus is based on the observation that individuals with dyslexia typically exhibit deficits in several of the cognitive areas evaluated by this digital tool. The robust internal consistency and multidimensional internal structure of the battery were demonstrated. This multimedia battery has proven to be a fitting tool for diagnosing children with reading difficulties in primary education, offering a comprehensive cognitive profile that is valuable not only for diagnostic purposes but also for tailoring individualized instructional plans.
Introduction
Dyslexia is a neurodevelopmental disorder characterized by difficulties in accurate and/or fluent word recognition and poor spelling and decoding abilities and is characterized by unexpected and persistent difficulty in acquiring efficient reading skills despite conventional instruction, adequate intelligence, and sociocultural opportunity1. This neurobiological disorder often manifests as challenges in reading, spelling, and writing, primarily due to phonological deficits2,3. “The importance of early identification of dyslexia cannot be overstated, as it allows for timely intervention and support4,5. When a student does not progress beyond Tier-3 in a response-to-intervention model, it becomes essential to conduct a more comprehensive assessment of both domain-general and domain-specific abilities associated with dyslexia, as highlighted by the scientific literature. The development of the technique presented here is grounded in the necessity of conducting thorough evaluations to ensure that appropriate interventions and support are provided. Moreover, previous studies underscore the utility of technology-based screening tools, such as web applications and computer games, in facilitating effective screening processes6,7. These studies collectively highlight the multifaceted nature of dyslexia, emphasizing the need for comprehensive assessment and intervention strategies to address the diverse cognitive profiles of individuals with dyslexia. Despite the prevalence of dyslexia among school-aged children, most available diagnostic tools lack a framework that comprehensively assesses both domain-general and domain-specific skills. Moreover, there are minimal computerized options, particularly for Spanish-speaking populations. This multimedia battery addresses these gaps by leveraging technology to facilitate a detailed assessment of cognitive skills linked to dyslexia.
Theoretical perspectives and cognitive deficits in Dyslexia
Various theoretical models, including phonological, rapid auditory processing, visual, magnocellular, and cerebellar theories, aim to explain the causes of dyslexia and inform interventions (see for a review)8. The phonological theory attributes dyslexia to difficulties in processing language sounds9, while the rapid auditory processing theory links dyslexia to deficits in perceiving rapidly changing sounds10. Visual theory highlights the visual aspects of reading difficulties, and magnocellular theory points to impairments in visual and auditory processing pathways11. The cerebellar theory suggests that dyslexia arises from cerebellar impairments affecting motor control and cognitive functions12. Nicolson and Fawcett's Delayed Neural Commitment (DNC) framework posits that slower skill acquisition and delayed neural network development are central to dyslexia. Recent models, such as the multiple deficit model, propose that dyslexia is a complex disorder influenced by genetic, cognitive, and environmental factors13,14,15. For instance, Ring and Black14 support the multiple deficit model, showing that both phonological and cognitive processing deficits contribute to the heterogeneity of dyslexia. Soriano-Ferrer et al.15 conducted a study with Spanish-speaking children with developmental dyslexia (DD) and found significant impairments in naming speed, verbal working memory, and phonological awareness (PA). Similarly, Zygouris et al.16 and Rauschenberger et al.6 underscore the importance of cognitive screening tools in identifying these deficits, with dyslexic individuals consistently scoring lower than typically achieving peers.
Examining technological approaches in Dyslexia screening: Insights from research studies
Research on dyslexia screening has evolved with three main approaches: early detection strategies, multifaceted screening methods combining various assessments, and integrating technology for enhanced efficiency17. Politi-Georgousi's18 recent systematic review highlights a shift toward more applications for intervening in dyslexia symptoms rather than screening processes, aligning with technology integration to improve reading skills in dyslexic students. Various tools exist, such as the Dyslexia Early Screening Test (DEST) by Fawcett and Nicolson, which assesses speed, phonological skills, motor skills, cerebellar function, and knowledge19. “Computer-based tools have advanced, including a web application assessing reading and cognitive skills in Greek children20 and tools by Hautala et al.21 and Rauschenberg et al.6 that use gaming and machine learning for early identification of dyslexia. Ahmad et al. integrated gaming with neural networks, achieving 95% accuracy in detection22. Studies across different orthographies underscore the importance of phonological awareness and rapid automatized naming in dyslexia identification23,24.
Insights into Dyslexia among Spanish-speaking children
The study of dyslexia in Spanish-speaking children has been significantly advanced through the use of Sicole-R technology. Jiménez et al. demonstrated its effectiveness in assessing dyslexia across age groups, particularly in distinguishing between dyslexic and typically achieving readers based on phonological and syntactic processing during early elementary years25. Guzmán et al. investigated naming speed deficits in dyslexic children with phonological challenges, highlighting interactions between dyslexia and naming speed measured through tasks such as letter-RAN and number-RAN26. Further studies by Jiménez et al. explored phonological awareness deficits across different syllable structures27, while Ortiz et al. investigated speech perception deficits among Spanish children with dyslexia, revealing impairments in speech perception development regardless of phonetic contrast or linguistic unit28,29. Jiménez et al. investigated the double-deficit hypothesis of dyslexia30, followed by analyses of cognitive processes and gender-related disparities in dyslexia prevalence31,32. Rodrigo et al. explored lexical access among Spanish dyslexic children33, and Jiménez et al. scrutinized syntactic processing deficits34. Finally, Jiménez et al. studied phonological and orthographical processes in dyslexic subtypes, highlighting differences in orthographic route efficiency35. These studies collectively enhance our understanding of the cognitive and linguistic challenges of dyslexia in Spanish-speaking populations.
The conducted studies share several common characteristics in terms of the age and background of the participating children. The children included in these studies ranged in age from 7 to 14 years. Most studies focused on primary school children aged between 7 and 12 years, except those that included children up to 14 years old, providing a sample that spans from early school years to preadolescence31,32. The participating children were primarily from the Canary Islands in Spain. Additionally, some studies included samples from other regions of Spain and Guatemala31,32. Participants were recruited from both public and private schools whose backgrounds included urban and suburban areas. The socioeconomic levels represented in these studies range from low-middle to working and middle class.
Together, these inquiries significantly advance our understanding of dyslexia's complexities, contributing to the field of dyslexia research. Adapted for use across multiple Ibero-American countries, including Spain, Guatemala, Chile, and Mexico, the tool facilitates the assessment of diagnostic accuracy and precision in a diverse Spanish-speaking sample for this study.
This study aimed to delineate a protocol for diagnosing Spanish-speaking children with reading difficulties using a specialized multimedia battery. The primary goal is to provide a comprehensive assessment tool that evaluates both domain-general and domain-specific skills associated with dyslexia.
Experimental setup overview
The SICOLE-R was programmed in the Java 2 Platform Standard Edition (J2SE). The HSQL database engine is used as a database. The software includes 6 main modules to be evaluated: 1) perceptual processing, which includes the tasks of voicing, placing, and manner of articulation; 2) phonological processing, which includes phoneme isolation, phoneme deletion, phoneme segmentation, and phoneme blending tasks; 3) naming speed, which includes the tasks of naming speed in numbers, letters, colors and pictures; 4) orthographic processing, which includes tasks of morphological comprehension of lexemes and suffixes and homophone comprehension; 5) syntactic processing, including gender, number, function words, and grammatical structure tasks; and 6) semantic processing, which influences reading comprehension tasks through informative and narrative text. Instructions for each task, accompanied by one or two trials (depending on the task) and a demonstration, are delivered by a pedagogical agent prior to the initiation of the testing phase. The application protocol for each task is illustrated here.
Prior to administering the multimedia battery to the study sample, adaptations were made to the Spanish language modality for each country (i.e., Mexico, Guatemala, Ecuador, and Chile), including adjustments to vocabulary, images, and other relevant content. The administration conditions were the same across all Latin American countries. The administration environment had to be quiet within the school and free from noise, distractions, and interruptions. The duration of the multimedia battery administration ranged from 3-4 sessions of 30 min each, depending on the student's ability and age. Due to its database compatibility with most spreadsheet and statistical data processing systems, the evaluator can analyze the results of each child and each task. Concerning the data collection, two distinct task types were employed: 1) tasks where the examiner records students' oral performance, noting successes and errors using an external mouse, and 2) tasks requiring students to independently select options by clicking on them.
Protocol
Representative Results
Discussion
In this study, confirmatory factor analysis (CFA) was employed to evaluate the factor structure of the Sicole-R battery, comprising one second-order factor and six latent variables representing different modules. The results indicated good model fit, convergent validity, and reliability, confirming the efficacy of the battery in assessing a comprehensive set of cognitive and reading skills that are critical for individuals with dyslexia. Importantly, the consistent performance of the digital tool across diverse demograph…
Disclosures
The authors have nothing to disclose.
Acknowledgements
We gratefully acknowledge the support provided by the Programa de la Agencia Española de Cooperación con Iberoamérica (AECI), enabling the adaptation of the technological tool Sicole-R-Primaria to the Spanish language variant of different countries within the Ibero-American space through the projects Evaluación de procesos cognitivos en la lectura mediante ayuda asistida a través de ordenador en población escolar de educación primaria (Assessment of Cognitive Processes in Reading through Computer-Assisted Aid in Primary School Student Population) in Guatemala (ref.: A/3877/05), Ecuador (ref.: C/030692/10), México (ref.: A/013941/07), and Chile (ref.: A/7548/07). Additionally, we would like to express our sincere gratitude to the Inter-American Development Bank (IDB) for their financial support toward the Ministry of Education (MEDUCA) of Panamá, with the Organization of Ibero-American States for Education, Science and Culture (OEI) acting as an intermediary. This funding has enabled the adaptation of the Sicole-R for use on both computers and tablets. We are also grateful for the support provided within the framework of Program PN-L1143; 4357/OC-PN, particularly the Technical Support for Facilitator Training and Review of Educational Resources. Additionally, we extend our appreciation for the External Products and Services Contract (PEC), which is aimed at offering specialized training to facilitate the detection, identification, and early intervention of Panamanian students who may be at risk of experiencing difficulties in reading, writing, and mathematics. For all the projects mentioned above, the first author served as the principal investigator.
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