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EXECUTIVE FUNCTIONS IN CHILDREN WITH DEVELOPMENTAL DYSLEXIA:

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EVIDENCES OF ALTERATIONS AND OPTIONS FOR INTERVENTION

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Ricardo Franco de Lima ; Cíntia Alves Salgado Azoni ; Sylvia Maria Ciasca

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Ph.D Student, Child Neuropsychologist, Department of Medical Psychology and Psychiatry, IDA Member; 2 Ph.D, Post-Doctor, Speech and

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Laboratory of Learning Disabilities and Attention Disorders (DISAPRE),

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School of Medical Sciences - University of Campinas - UNICAMP - Campinas, SP, Brazil.

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Table 3. Comparison of groups using neuropsychological instruments

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ABSTRACT

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The aim of this study was to determine whether children with dyslexia have difficulties in different components of Executive Functions (EF). We compared the performance of children with dyslexia and Dyslexia (n=31) Control (n=30)

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Scores p-value d
M(SD) M(SD)
children without learning disabilities in neuropsychological instruments. The assessment of these cognitive functions can help in the rehabilitation process of children with reading and writing disorder.

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Cod 9,58 (2,43) 11,67 (2,48) 0,006 -0,89
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SS 10,55 (1,96) 12,90 (1,73) 0,001 -1,27
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INTRODUCTION

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PSI 99,00 (10,39) 110,23 (13,01) 0,001 -0,95

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CT-GF/Time 95,29 (22,38) 92,63 (22,60) 0,356 0,12

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Brazilian studies on Developmental Dyslexia (DD) that investigate other cognitive domains, ***

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Materials CT-GF/Errors 1,77 (2,86) 0,53 (0,86) 0,171 0,59
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besides language, are scarce. Among these functions, studies show that dyslexics have more CT-LR/Time 144,87 (47,34) 141,70 (44,64) 0,937 0,07
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The instruments used were (Table 2):

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CT-LR/Errors 5,06 (4,72) 1,63 (2,48) 0,001 0,91

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reaction time on tests of visual attention 1, diffuse distribution of visual-spatial processing

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TMT-A/Time 58,32 (16,20) 57,73 (22,21) 0,588 0,03
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resources 2,3 and specially in processing of verbal stimuli 4.

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TMT-A/Errors 0,16 (0,64) 0,07 (0,37) 0,563 0,17

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TMT-B/Time 180,32 (82,96) 134,07 (46,69) 0,036 0,69
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Additionally, studies have reported impairment in different components of executive functions: *** ***

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TMT-B/switching errors 0,90 (1,49) 0,00 (0,00) 0,001 0,85

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Table 2. Neuropsychological test battery

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inhibitory control 5-8, flexibility and switching 9, use of cognitive strategies 7, verbal working memory TMT-B/sequencing erros 0,77 (1,12) 0,07 (0,37) 0,002
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0,84
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5,8 *** ***
, and other subcomponents of working memory 10. In planning tasks are not described differences SCWT-C/Time 22,45 (4,88) 16,70 (3,62) 0,001 1,34

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Cognitive function Test procedure SCWT-C/Errors 1,16 (1,07) 0,20 (0,48) 0,001
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1,16
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between dyslexics and controls in the total scores, however, such differences are observed in the Attention WISC-III subtests: Coding (Cod), Symbol Search (SS) SCWT-W/Time 19,77 (5,38) 12,07 (2,88) 0,001
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1,78
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time of planning 5.
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SCWT-W/Errors 0,65 (0,88) 0,00 (0,00) 0,001 1,04

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WISC-III index: Speed od Processing (PSI)

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SCWT-CW/Time 44,00 (17,18) 36,03 (7,95) 0,065 0,60
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Despite this evidence, few studies conducted in Brazilian context have focused on the Cancellation Test (Geometric Figures – CT/GFand Letters in *** ***
SCWT-CW/Errors 4,94 (3,20) 2,27 (1,96) 0,001 1,01

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Row– CT/LR)

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characterization of these functions in children with learning disabilities. ***
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ToL 19,55 (3,12) 20,97 (2,58) 0,104 -0,50

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Shifting and flexibility Trail Making Test - Part A/B (TMT) WCST – TA 117,03 (16,72) 107,20 (20,11) 0,055 0,53
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Inhibitory Control Stroop Color Word Test (SCWT) WCST – TC 21,23 (29,09) 15,23 (9,64) 0,045 0,28

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WCST – CC 4,13 (1,96) 5,03 (1,43) 0,051 -0,52

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Planning, problem solving Tower of London (ToL)

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OBJECTIVE WCST – NS 66,77 (16,17) 70,00 (9,36) 0,613 -0,24

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Cognitive strategies, concept Wisconsin Card Sorting Test (WCST) *** ***

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WCST – NE 59,10 (34,39) 81,07 (19,90) 0,006 -0,78

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The aim of this study was to compare performance of children with Developmental Dyslexia and
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formation WSCT – EP 13,52 (15,01) 28,40 (20,77) 0,001 -0,82

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children without learning difficulties in instruments of Executive Functions. *** ***

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Phonetic and semantic fluency Verbal Fluency Test (FAS) WCST – CLR 60,39 (33,75) 79,53 (21,56) 0,014 -0,68
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Dig 3,03 (0,84) 4,97 (1,90) 0,001 -1,32
Verbal Working Memory Digit Span Backward (Dig) *** ***

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FVF 18,70 (6,37) 26,13 (6,42) 0,001 -1,16
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FVS 32,26 (8,50) 33,43 (6,03) 0,403 -0,16

METHOD
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Legend. TMT: trail making test; SCWT: stroop color word test; ToL: tower of London; WCST-TA: Wisconsin

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Participants card sorting test - tests administered; WCST-TC: trials to complete the first category; WCST-CC: completed
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Procedure category; WCST-NS: number of successes; WCST-NE: number of errors; WCST-EP: error percentage;
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The study included a total of 61 children of both genders, aged between 7-14 years old, average

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The study was approved by the Research Ethics Committee of the Faculty of Medical Sciences WCST CLR: conceptual level responses; M(SD): mean (standard deviation).

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age of 9.71 (SD=1.57) years, attending the 2-8th grades of elementary school, divided into two
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Note. *Mann-Whitney Test; ** Cohen's d; ***
(UNICAMP). The children were assessed individually by a single examiner in the rooms of the
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groups (Table 1):

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Outpatient Clinic of Neuro-Learning Difficulties or school, according to the group, and after parents

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(a)Dyslexia (GD): 31 children (71% of boys and 29% of girls) with interdisciplinary diagnosis signing the consent form.
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Previous studies have demonstrated the importance of clinical intervention and strategy

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(neuropsychology, speech language pathologist, educational psychology, neurology and

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instruction for children with dyslexia and other learning disabilities 14,15. We suggest a Program of
psychiatry) of Developmental Dyslexia. For diagnosis we followed the criteria of International

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Neuropsychological Rehabilitation for the children with Developmental Dyslexia. This program

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Statistical analysis
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Classification of Diseases ICD-10 11, and clinical characteristics;

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Statistical analysis was performed using the program SPSS Statistics 20.0 for Windows and aims to stimulate the development of Executive Functions and it is composed by modules
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(b)Control (CG): 30 children (53% of boys and 47% of girls) without learning disabilities and/or (Table 4).
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attention disorder, proficient readers, evaluated at a public school. adopting a significance level of p <.05. To compare means between groups we used the Mann-
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Whitney nonparametric test. Additionally was calculated measure of effect size (Cohen's d).

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Criteria selection: consent form signed by, presenting an intellectual level as expected, i.e.,
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Table 4. Program of Neuropsychological Rehabilitation

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Intelligence Quotient (IQ) above 80, do not make use of psychotropic medicine, not to present

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other neurological symptoms, without ADHD and for the CG does not present any type of learning RESULTS AND DISCUSSION
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Psycho education
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difficulty.

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Orientations for parents and teachers

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The statistical analysis revealed differences between groups on scores of different instruments:

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subtests of the WISC-III Arithmetic, Digit Span, Coding, Symbol Search, Distraction Resistance Attention training tasks
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Table 1. Sample caracterization

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Strategies for: t ime management, note-taking, test -taking, studying, assignments,

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Index, Processing Speed Index, and omission errors of Cancellation Test, Digit Span Backward

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homework, problem-solution
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(WISC-III), TMT, SCWT, WCST and FAS (phonological category). There were no differences

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Variables DG CG Total p-value

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between groups in the ToL (Table 3). In all instruments GD showed impaired performance. Self-regulated strategies for comprehension reading and writing production

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Gender f (%) f (%) f (%)
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As other studies studies 1-10,12,13 the findings suggest that children with Developmental Dyslexia
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Male 22 (71) 16 (53) 38 (62) have difficulties in different components of EF: visual attention, processing speed, flexibility,
.16 CONCLUSION
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Female 09 (29) 14 (47) 23 (38) inhibitory control, use of strategies, working memory and verbal fluency. As indicated by the study
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We found that children with Developmental Dyslexia may show alterations in Executive Functions. The
of Reiter et al. 5, no significant impairment in ToL score was observed.
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Grades f (%) f (%) f (%)

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assessment of these functions can help in the rehabilitation of children with reading and writing

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disorder.
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-4 11 (36) 15 (50) 26 (43)
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-8 20 (65) 15 (50) 35 (57)
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Age f (%) f (%) f (%)

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REFERENCES

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-9 10 (32) 19 (63) 29 (48) 1 Heiervang, E., & Hugdahl, K. (2003). Impaired visual in children with dyslexia. J Learning Disabilities, 36, 68-73.
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<.05*
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10-14 21 (68) 11 (37) 32 (52) 2 Facoetti, A., Lorusso, M.L., Paganoni, P., Cattaneo, C, Galli, R., Mascetti, G.G. (2003). The time course of attentional focusing in dyslexic and normally reading children. Brain and Cognition,53,181-18.

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3 Visser, T.A.W., Boden, C., Giaschi, D.E. (2004). Children with dyslexia: evidence for visual attention deficits in perception of rapid sequences of objects. Vision Research,44,2521-35.
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4 Ziegler, 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,F8-F14.
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M(SD) 10.5(1.65) 9.0(1.07) 9.72(1.57) <.05* 5 Reiter, A., Tucha, O., Lange, K.W. (2005). Executive Functions in Children with Dyslexia. Dyslexia,11,116-31.
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M(SD) M(SD) M(SD)
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IQ’s(WISC III) 6 Everatt J.M., Warner, J., Miles, T.R., & Thomson, M.E. (1997). The incidence of Stroop interference in dyslexia. Dyslexia,3,222-8.
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102.65 (15.52) 118.20 (11.74) 110.30 (15.76) 7 Helland, T. & Asbjornsen A. (2000). Executive functions in dyslexia. Child Neuropsychol, 6,37-48.

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Verbal <.001*** 8 Brosnan, M., Demetre, J., Hamill, S., Robson, K., Shepherd, H., & Cody, G. (2002). Executive functioning in adults and children with developmental dyslexia. Neuropsychologia,40,2144-55.
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Average High Average High Average
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9 Van Der Sluis, S., De Jong, P.F., & Van Der Lij, A. (2004). Inhibition and shifting in children with learning deficits in arithmetic and reading. J Exp Child Psychol,87,239-266.
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103.61 (11.35) 114.10 (13.29) 108.77 (13.33) b
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Performance <.01** 10 Schuchardt, K., Maehler, C., & Hasselhorn, M. (2008). Working memory in children with specific learning disorders. J Learning Disabilities,41,514-523.
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Average High Average Average

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11 World Health Organization WHO. (2008). The ICD-10 Classification of Mental and Behavioural Disorders descriptions and diagnostic guidelines. Geneva: World Health Organization.

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103.39 (13.21) 117.63 (12.00) 110.39 (14.44)

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Full <.001***
b 12 Marzocchi, G.M., Ornaghi, S., Barboglio, S. (2009). What are the causes of the attention deficits observed in children with dyslexia? Child Neuropsychol,15,567-81.
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Average High Average High Average 13 Ruffino, M., Trussardi, A.N., Gori, S., Finzi, A., Giovagnoli, S., Menghini, D. et al. (2010). Attentional engagement deficits in dyslexic children. Neuropsychologia,48,3793-801.
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Legend. f: frequency; Min: Minimum; Max: Maximum; M(SD): Mean (Standard Deviation). 14 Meltzer, L. (2012). Executive Functions in Education: from theory to practice. The Guilford Press: New York.
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Note. *p<.05; **p<.01; ***p<.001; aChi-square test; bMann-Whitney test 15 García-Sánchez, J.N., Fidalgo-Redondo, R. (2006). Effects of two types of self-regulatory instruction programs on students with learning disabilities in writing products, processes, and self-efficacy. Learning Disability Quarterly, 29, 181-211.
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