Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts.
School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Pediatrics. 2020 Jul;146(1). doi: 10.1542/peds.2019-3046. Epub 2020 Jun 23.
Dyslexia is a common learning disorder that renders children susceptible to poor health outcomes and many elements of socioeconomic difficulty. It is commonly undiagnosed until a child has repeatedly failed to learn to read in elementary school; this late diagnosis not only places the child at an academic disadvantage but also can be a precursor to psychiatric comorbidities such as anxiety and depression. Genetic and neuroimaging research have revealed that dyslexia is heritable and that it is undergirded by brain differences that are present even before reading instruction begins. Cognitive-behavioral research has revealed that there are early literacy skill deficits that represent red flags for dyslexia risk and can be measured at a preschool age. Altogether, this evidence points to dyslexia as a disorder that can be flagged by a pediatrician before school entry, during a period of heightened brain plasticity when interventions are more likely to be effective. In this review, we discuss the clinical implications of the most recent advances in dyslexia research, which converge to indicate that early identification and screening are crucial to the prevention or mitigation of adverse secondary consequences of dyslexia. We further highlight evidence-based and practical strategies for the implementation of early risk identification in pediatric practice so that physicians can be empowered in their ability to treat, educate, and advocate for their patients and families with dyslexia.
阅读障碍是一种常见的学习障碍,使儿童容易出现健康状况不佳和许多社会经济困难的情况。直到孩子在小学反复未能学会阅读时,这种疾病才经常被诊断出来;这种晚期诊断不仅使孩子在学业上处于劣势,而且还可能导致焦虑和抑郁等精神共病。遗传和神经影像学研究表明,阅读障碍是可遗传的,并且它是由大脑差异支撑的,即使在开始阅读教学之前,这些差异就已经存在。认知行为研究表明,存在早期读写技能缺陷,这是阅读障碍风险的预警信号,可以在学龄前进行测量。总之,这些证据表明,阅读障碍是一种可以在入学前由儿科医生标记的疾病,此时大脑具有较高的可塑性,干预措施更有可能有效。在这篇综述中,我们讨论了阅读障碍研究最新进展的临床意义,这些进展表明早期识别和筛查对于预防或减轻阅读障碍的不良继发后果至关重要。我们进一步强调了在儿科实践中实施早期风险识别的循证和实用策略,以使医生能够提高治疗、教育和为阅读障碍患者及其家庭提供支持的能力。