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什么导致了诵读困难?病因分析与有效补偿治疗。

What causes dyslexia? Identifying the causes and effective compensatory therapy.

机构信息

Institute for Social Pediatrics and Adolescent Medicine Ludwig-Maximilians-University of Munich, Munich, Germany.

出版信息

Restor Neurol Neurosci. 2019;37(6):591-608. doi: 10.3233/RNN-190939.

Abstract

BackgroundChildren are diagnosed as dyslexic when their reading performance is much below that which could be expected for their educational level and cannot be explained by a sensory, neurological or psychiatric deficit or by a low IQ. Although poor reading is a major obstacle to school and career achievement, the causes of dyslexia are unclear and traditional therapies are often unsuccessful. To determine the causes of dyslexia, experiments must demonstrate under which conditions a reading disorder occurs and whether the reading performance improves if these conditions are abolished or compensated. To avoid irreproducible results, experiments must be repeated and the effect size must be calculated.ObjectivesThe aims of the study were to investigate the rate and location of misread letters within pseudowords, prove the effectiveness of compensatory reading therapy and demonstrate the reproducibility of the experimental results. The influence of reading therapy on the rate of eye movements opposite to the reading direction was investigated and causes of a poor reading performance were identified.MethodsThe rate and location of misread letters were investigated by tachystoscopic presentation of pseudowords containing between three and six letters. Presentation time, fixation time, and the time it takes to begin pronouncing the words (speech onset latency) were changed until 95% of the pseudowords were recognized correctly. On the basis of these results, the children learned a reading strategy that compensated the causes of the reading disorder. The therapy was demonstrated to be highly effective and it was shown that the results of the therapy were reproducible.ResultsIt was shown that misread letters occurred at all locations in pseudowords, regardless of the word's length. Inadequate fixation, excessively large saccadic amplitudes, reduced ability to simultaneously recognize a sequence of letters, a longer required fixation time and a longer required speech onset latency were all identified as causes of dyslexia. Each of the studies included in the meta-analysis were much more efficient than conventional therapeutic methods. The overall effect size with a value of Hedges' G = 1.72 showed that the therapy had a reproducible and stable effect.ConclusionsThe causes of dyslexia can be revealed by a dual-intervention approach consisting of a pseudoword experiment and learning a compensatory reading strategy. Reading performance improves immediately if the identified causes of dyslexia are compensated by an appropriate reading therapy.

摘要

背景

当儿童的阅读表现明显低于其教育水平应有的水平,且无法用感觉、神经或精神缺陷或低智商来解释时,他们会被诊断为阅读障碍。尽管阅读困难是学业和职业成就的主要障碍,但阅读障碍的原因尚不清楚,传统的治疗方法往往也不成功。为了确定阅读障碍的原因,实验必须证明在何种条件下会出现阅读障碍,以及如果消除或补偿这些条件,阅读表现是否会提高。为了避免不可重复的结果,实验必须重复进行,并且必须计算效应大小。目的:本研究的目的是调查假词中误读字母的频率和位置,证明补偿性阅读疗法的有效性,并证明实验结果的可重复性。还研究了阅读疗法对阅读方向相反的眼球运动速度的影响,并确定了阅读表现不佳的原因。方法:通过快速呈现包含 3 到 6 个字母的假词来研究误读字母的频率和位置。改变呈现时间、注视时间和开始发音的时间(言语起始潜伏期),直到 95%的假词被正确识别。基于这些结果,孩子们学习了一种补偿阅读障碍原因的阅读策略。该疗法被证明非常有效,并且表明该疗法的结果具有可重复性。结果:研究表明,假词中的误读字母出现在所有位置,与单词的长度无关。不合适的注视、过大的眼跳幅度、同时识别一系列字母的能力下降、需要更长的注视时间和更长的言语起始潜伏期,这些都是阅读障碍的原因。元分析中包含的每项研究都比传统的治疗方法更有效。Hedges'G 值为 1.72 的总体效应大小表明,该疗法具有可重复和稳定的效果。结论:通过由假词实验和学习补偿性阅读策略组成的双重干预方法,可以揭示阅读障碍的原因。如果通过适当的阅读疗法补偿了阅读障碍的原因,阅读表现会立即得到改善。

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