Shaywitz Sally E, Shaywitz Bennett A
Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
Dev Psychopathol. 2008 Fall;20(4):1329-49. doi: 10.1017/S0954579408000631.
Extraordinary progress in functional brain imaging, primarily advances in functional magnetic resonance imaging, now allows scientists to understand the neural systems serving reading and how these systems differ in dyslexic readers. Scientists now speak of the neural signature of dyslexia, a singular achievement that for the first time has made what was previously a hidden disability, now visible. Paralleling this achievement in understanding the neurobiology of dyslexia, progress in the identification and treatment of dyslexia now offers the hope of identifying children at risk for dyslexia at a very young age and providing evidence-based, effective interventions. Despite these advances, for many dyslexic readers, becoming a skilled, automatic reader remains elusive, in great part because though children with dyslexia can be taught to decode words, teaching children to read fluently and automatically represents the next frontier in research on dyslexia. We suggest that to break through this "fluency" barrier, investigators will need to reexamine the more than 20-year-old central dogma in reading research: the generation of the phonological code from print is modular, that is, automatic and not attention demanding, and not requiring any other cognitive process. Recent findings now present a competing view: other cognitive processes are involved in reading, particularly attentional mechanisms, and that disruption of these attentional mechanisms play a causal role in reading difficulties. Recognition of the role of attentional mechanisms in reading now offer potentially new strategies for interventions in dyslexia. In particular, the use of pharmacotherapeutic agents affecting attentional mechanisms not only may provide a window into the neurochemical mechanisms underlying dyslexia but also may offer a potential adjunct treatment for teaching dyslexic readers to read fluently and automatically. Preliminary studies suggest that agents traditionally used to treat disorders of attention, particularly attention-deficit/hyperactivity disorder, may prove to be an effective adjunct to improving reading in dyslexic students.
功能性脑成像取得了非凡进展，主要是功能磁共振成像的进步，现在使科学家能够了解服务于阅读的神经系统，以及这些系统在阅读障碍读者中是如何不同的。科学家们现在谈到了阅读障碍的神经特征，这一独特成就首次使以前隐藏的残疾现在变得可见。与在理解阅读障碍神经生物学方面的这一成就相平行的是，阅读障碍的识别和治疗方面的进展现在为在非常年幼时识别有阅读障碍风险的儿童并提供基于证据的有效干预措施带来了希望。尽管有这些进展，但对于许多阅读障碍读者来说，成为熟练的、自动的阅读者仍然难以实现，很大程度上是因为虽然阅读障碍儿童可以被教导解码单词，但教儿童流利和自动地阅读代表了阅读障碍研究的下一个前沿领域。我们认为，要突破这个“流利度”障碍，研究人员将需要重新审视阅读研究中已有20多年历史的核心教条：从印刷品中生成语音代码是模块化的，也就是说，是自动的，不需要注意力，也不需要任何其他认知过程。最近的研究结果现在提出了一种与之竞争的观点：其他认知过程参与了阅读，特别是注意力机制，并且这些注意力机制的破坏在阅读困难中起因果作用。认识到注意力机制在阅读中的作用现在为阅读障碍的干预提供了潜在的新策略。特别是，使用影响注意力机制的药物治疗剂不仅可能为阅读障碍背后的神经化学机制提供一个窗口，而且可能为教阅读障碍读者流利和自动地阅读提供一种潜在的辅助治疗方法。初步研究表明，传统上用于治疗注意力障碍，特别是注意力缺陷多动障碍的药物，可能被证明是提高阅读障碍学生阅读能力的有效辅助手段。
