Reading in developmental dyslexia: the role of phonemic awareness and executive functions

MEDINA, Giovanna Beatriz Kalva; GUIMARÃES, Sandra Regina Kirchner

doi:10.1590/1982-0275202138e180178

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THEMATIC SECTION: READING, WRITING AND MATH LEARNING: COGNITIVE CORRELATES • Estud. psicol. 38 • 2021 • https://doi.org/10.1590/1982-0275202138e180178 copy

Reading in developmental dyslexia: the role of phonemic awareness and executive functions

Leitura na dislexia do desenvolvimento: o papel da consciência fonêmica e das funções executivas

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study investigated the correlations and the possible deficits in reading, phonemic awareness, and executive functions among students with developmental dyslexia. A total of 28 students participated in the study, between 9 and 11 years old, 14 with developmental dyslexia and 14 without reading difficulties. Specific instruments were used to assess reading, phonemic awareness, and executive functions. The Spearman test indicated moderate and very significant correlations between performance in tasks of phonemic awareness and reading (recognition and comprehension) and tasks that assessed cognitive functioning involving the following executive functions: cognitive flexibility, working memory, inhibitory control, and orthographic verbal fluency. No correlation was found between the reading and phonemic awareness assessments and the results of the planning done with the Tower of London instrument. The results allowed the researchers to hypothesize that an intervention planned for the development of phonemic awareness and executive functions may have an effect in improving the reading performance of dyslexics.

Keywords
Awareness; Dyslexia, Developmental; Executive function; Reading

Instrument	Assessed area	Procedure
TDE reading subtest (Stein, 1994Stein, L. M. (1994). TDE – Teste de Desempenho Escolar: manual para aplicação e interpretação. São Paulo: Casa do Psicólogo.).	Reading Isolated Words.	The participant should read 70 isolated words aloud. These words have an increasing degree of difficulty. There is no minimum application time. The test is interrupted when the child misses a sequence of 5 words.
PROLEC (Capellini, Oliveira & Cuetos, 2014Capellini, S. A., Oliveira, A., & Cuetos, F. (2014). PROLEC – Provas de avaliação dos processos de leitura. São Paulo: Casa do Psicólogo.). Subtask of understanding small texts.	Reading isolated words and reading and understanding small texts.	The participant should read isolated words and small texts aloud. The test was interrupted if the participant was unable to read an appropriate sequence of 5 words.
TELCS – Reading test: sentence understanding (Vilhena et al., 2016Vilhena, D. A., Sucena, A., Castro, S. L., & Pinheiro, A. M. V. (2016). Reading test – sentence comprehension: an adapted version of Lobrot’s lecture 3 test for brazilian portuguese. Dyslexia, 22(1), 47-63. https://doi.org/10.1002/dys.1521 https://doi.org/10.1002/dys.1521... ).	Reading and understanding sentences.	The participant should read an incomplete sentence and choose, among five words, the one that best completed the sentence, to demonstrate whether he or she understood its content.
TCFe, Phonemic Awareness Tasks (Godoy & Cogo-Moreira, 2015Godoy, D. M. A., & Cogo-Moreira, H. (2015). Evidences of factorial structure and precision of phonemic awareness tasks (TCFe). Paidéia, 25(62), 363-372. http://dx.doi.org/10.1590/1982-43272562201510 https://doi.org/10.1590/1982-43272562201... ).	Phonemic awareness.	The participant should perform phonemic subtraction (CVC* and CCV), phonemic inversion (VC, CV, CVC and VCV), segmentation and auditory acronyms with pseudowords. C = consonant; V = vowel
Trail Test (parts A and B) (Montiel & Seabra, 2012bMontiel, J. M., & Seabra, A. G. (2012b). Teste de trilhas: partes A e B. In A. G. Seabra & N. M. Dias (Orgs.), Avaliação neuropsicológica cognitiva: atenção e funções executivas (pp. 79-85). São Paulo: Memnon.).	Cognitive flexibility.	In the first part (Part A), the participant should conduct a visual search and connect the numbers in the numerical sequence, and later he or she should connect the letters in the alphabetical order. In the second part (part B), the participant would need to link the items, alternating the sequence of letters and numbers (1-A, 2-B, 3-C, etc.), in a maximum time of one minute.
Attention Cancellation Test (Montiel & Seabra, 2012aMontiel, J. M., & Seabra, A. G. (2012a). Teste de atenção por cancelamento. In A. G. Seabra & N. M. Dias (Orgs.), Avaliação neuropsicológica cognitiva: atenção e funções executivas (pp. 57-66). São Paulo: Memnon.).	Inhibitory control / selective attention.	This test consists of three activities, in which the participant needed to mark certain symbols, according to the model presented. In the first part, only one symbol was presented, in the second, a pair of symbols that should only be marked when they appear together and, finally, the target stimulus was changed in each line of the test.
Tower of London Test (Seabra et al., 2012Seabra, A. G., Dias, N. M., Barberian, A. A., Assef, E. C. F., & Cozza, H. F. P. (2012). Teste da Torre de Londres. In A. G. Seabra & N. M. Dias (Orgs.), Avaliação neuropsicológica cognitiva: atenção e funções executivas (pp. 79-85). São Paulo: Memnon.).	Planning.	This instrument consists of a wooden base, with three pins of different sizes, and three spheres (red, blue, and green). The participant received a problem with a card, in which the spheres would be in a certain position, and they should reach that result with the least number of movements possible. The student had three chances to solve each problem. The score was assigned according to the number of attempts. The time to execute the text was recorded by the examiner.
Working memory - NEUPSILIN-INF (Salles et al., 2016Salles, J. F., Fonseca, R. P., Parente, M. A., Cruz-Rodrigues, C., Mello, C. B., Barbosa, T., & Miranda, M. C. (2016). NEUPSILIN-INF: instrumento de avaliação neuropsicológica breve para crianças. São Paulo: Vetor.). Four tasks comprising the working memory assessment: repetition of digits in forward and reverse orders, span of pseudowords, and visuospatial component assessment.	Auditory attention, central executive, phonological, and visuospatial components of working memory.	In the tests of repetition of digits in forward and inverse order, the participant was asked to repeat the digits according to the orientation of the examiner. The test was interrupted in both tasks, after the participant missed three consecutive digit sequences. In the Pseudoword Span, the participant needed to repeat pseudowords in the order presented by the examiner. And, in the visuospatial working memory task, the child was asked to repeat some of the examiner’s movements, however, in reverse order. For this test, a matrix with eight squares was used, to which the examiner pointed in a certain order. The child observed and then should correctly reproduce the movements.
Go/No Go Task – NEUPSILIN-INF (Salles et al., 2016Salles, J. F., Fonseca, R. P., Parente, M. A., Cruz-Rodrigues, C., Mello, C. B., Barbosa, T., & Miranda, M. C. (2016). NEUPSILIN-INF: instrumento de avaliação neuropsicológica breve para crianças. São Paulo: Vetor.).	Inhibitory control through auditory stimuli.	The participant heard a sequence of numbers on a stereo, recited with a pause of one second between each number, and then had to say the word “yes” when he or she heard each number, except when he or she heard the number eight, in which the child should remain silent. Errors and omissions were computed, for a total of 60 stimuli.
Verbal Fluency Task – NEUPSILIN-INF (Salles et al., 2016Salles, J. F., Fonseca, R. P., Parente, M. A., Cruz-Rodrigues, C., Mello, C. B., Barbosa, T., & Miranda, M. C. (2016). NEUPSILIN-INF: instrumento de avaliação neuropsicológica breve para crianças. São Paulo: Vetor.).	Verbal fluency. Executive functions.	The participant was asked to evoke all the words he or she could remember that started with the letter M. The semantic task requires that the examiner think and speak as many words of a given semantic category, for example animals, as quickly as possible. The time to perform each task was one minute for each category.

Dyslexics group X Control group by age	Dyslexics		Control Group		U	p
Dyslexics group X Control group by age	Mean	Median	Mean	Median	U	p
Age	10.34	10.11	9.89	9.79	76.500	0.323^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
TDE – Word reading	23.50	17.50	65.86	67.00	1.500	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
PROLEC – Frequent word reading	10.29	10.00	19.79	20.00	8.000	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
PROLEC – Rare word reading	7.93	8.00	18.43	19.00	0.500	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
PROLEC – Pseudoword reading	6.79	8.00	18.14	19.00	3.000	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
PROLEC – Frequent, rare, pseudoword reading	25.00	26.00	56.36	58.00	58.000	*0.015^ * p < 0.05;**
TELCS – Understanding sentences	2.50	0.00	19.79	19.00	4.000	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
PROLEC – Text comprehension	3.36	0.00	12.00	12.50	12.500	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
PROLEC – Overall Score	97.50	97.50	194.43	198.50	0.000	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Phonemic awareness	9.57	4.50	48.86	52.50	1.000	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Trails – A	17.14	19.00	22.36	24.00	40.000	0.005^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Cognitive Flexibility – Trails – B	6.14	6.50	13.64	14.50	9.500	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Working memory – Forward digits	17.36	18.00	22.57	24.00	34.000	0.003^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Working memory – Reverse digits	11.21	12.50	17.79	19.50	36.000	0.004^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Working memory – Pseudoword span	9.79	9.00	12.64	13.00	51.500	*0.032^ * p < 0.05;**
Working memory – Visuospatial	17.43	17.50	23.71	23.00	41.000	0.008^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Working memory – Total score	55.79	59.00	16.71	78.50	21.000	0.000^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Planning – Tower of London	28.50	28.50	28.43	29.00	97.000	0.963^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Planning – Tower of London – Execution time (seconds)	302.93	282.50	269.93	274.50	84.000	0.520^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Orthographic verbal fluency	3.79	3.00	6.86	7.00	36.000	0.004^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Semantic verbal fluency	12.43	12.00	14.36	13.00	78.000	0.355^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Verbal fluency – Total score	16.21	16.00	21.21	20.00	52.000	*0.034^ * p < 0.05;**
Inhibitory control – Go/No Go	50.57	51.50	54.43	54.00	50.000	*0.026^ * p < 0.05;**
Inhibitory control – Go/No Go – Errors	5.43	4.00	2.79	2.50	39.500	0.006^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Inhibitory control – Go/No Go – Omissions	3.86	2.50	2.64	2.00	77.500	0.339^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Inhibitory control – Cancellation – Total score	76.14	79.00	83.00	84.00	65.000	0.129^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Inhibitory control – Cancellation – Total errors	0.57	0.00	0.14	0.00	82.000	0.304^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.
Inhibitory control – Cancellation – Total omissions	31.79	29.00	25.29	25.50	68.500	0.175^ p < 0.01. PROLEC: Assessment of Reading Processes; TDE: School Performance Test (reading subtask); TELCS: Reading Test: Understanding Sentences. Degree of freedom equal to 2. For better visualization, indices with significant correlation were marked in bold, that is, when p < 0.05.

Variables	Age		TDE		TELCS		PROLEC – Comprehension		Phonemic Awareness
Variables	rho	p	rho	p	rho	p	rho	p	rho	p
Age	1.000^ p < 0.01.
TDE	-0.105^ p < 0.01.	0.596	1.000^ p < 0.01.
TELCS	-0.032^ p < 0.01.	0.870	0.917^ p < 0.01.	0.000	1.000^ p < 0.01.
PROLEC – Understanding	-0.119^ p < 0.01.	0.547	0.840^ p < 0.01.	0.000	0.866^ p < 0.01.	0.000	1.000^* * p < 0.05;
Phonemic Awareness	-0.151^ p < 0.01.	0.442	0.905^ p < 0.01.	0.000	0.886^ p < 0.01.	0.000	0.835^ p < 0.01.	0.000	1.000^* * p < 0.05;
CF – Trails – A	-0.267^ p < 0.01.	0.170	0.545^ p < 0.01.	0.003	0.492^ p < 0.01.	0.008	0.362^ p < 0.01.	0.058	0.554^ p < 0.01.	0.002
CF –Trails – B	-0.091^ p < 0.01.	0.645	0.672^ p < 0.01.	0.000	0.754^ p < 0.01.	0.000	0.658^ p < 0.01.	0.000	0.772^ p < 0.01.	0.000
WM – Direct digits	-0.259^ p < 0.01.	0.183	0.643^ p < 0.01.	0.000	0.666^ p < 0.01.	0.000	0.624^ p < 0.01.	0.000	0.608^ p < 0.01.	0.001
WM – Reverse digits	-0.357^ p < 0.01.	0.062	0.631^ p < 0.01.	0.000	0.637^ p < 0.01.	0.000	0.733^ p < 0.01.	0.000	0.715^ p < 0.01.	0.000
WM – Pseudoword span	-0.188^ p < 0.01.	0.337	*0.478^ * p < 0.05;**	0.010	0.407^ p < 0.01.	0.032	0.395^ p < 0.01.	0.038	0.384^* * p < 0.05;	0.044
WM – Visuospatial	0.126^ p < 0.01.	0.523	0.504^ p < 0.01.	0.006	0.501^ p < 0.01.	0.007	0.479^ p < 0.01.	0.010	*0.436^ * p < 0.05;**	0.020
WM – Total score	-0.209^ p < 0.01.	0.285	0.746^ p < 0.01.	0.000	0.742^ p < 0.01.	0.000	0.746^ p < 0.01.	0.000	0.744^ p < 0.01.	0.000
Planning – Tower of London	0.336^ p < 0.01.	0.081	0.081^ p < 0.01.	0.682	0.078^ p < 0.01.	0.692	0.133^ p < 0.01.	0.499	0.023^ p < 0.01.	0.906
Planning – Tower of London – Execution time (seconds)	0.014^ p < 0.01.	0.945	-0.145^ p < 0.01.	0.462	-0.157^ p < 0.01.	0.425	-0.221^ p < 0.01.	0.259	0.036^ p < 0.01.	0.858
Spelling verbal fluency	-0.008^ p < 0.01.	0.967	0.563^ p < 0.01.	0.002	0.660^ p < 0.01.	0.000	0.505^ p < 0.01.	0.006	0.607^ p < 0.01.	0.001
Semantic verbal fluency	-0.090^ p < 0.01.	0.648	0.331^ p < 0.01.	0.086	0.362^ p < 0.01.	0.058	0.225^ p < 0.01.	0.251	0.316^ p < 0.01.	0.102
Verbal fluency – Total score	-0.061^ p < 0.01.	0.758	0.540^ p < 0.01.	0.003	0.588^ p < 0.01.	0.001	0.399^* * p < 0.05;	0.035	0.543^ p < 0.01.	0.003
IC – Go/No Go	-0.009^ p < 0.01.	0.964	0.556^ p < 0.01.	0.002	0.511^ p < 0.01.	0.005	0.550^ p < 0.01.	0.002	*0.396^ * p < 0.05;**	0.037
IC – Go/No Go – Errors	0.109^ p < 0.01.	0.582	-0.572^ p < 0.01.	0.001	-0.561^ p < 0.01.	0.002	-0.400^ p < 0.01.	0.035	-0.482^ p < 0.01.	0.009
IC – Go/No Go – Omissions	-0.109^ p < 0.01.	0.582	-0.273^ p < 0.01.	0.159	-0.268^ p < 0.01.	0.167	-0.379^ p < 0.01.	0.047	-0.148^ p < 0.01.	0.451
IC – Cancellation – Total score	0.088^ p < 0.01.	0.657	0.359^ p < 0.01.	0.061	.0377^* * p < 0.05;	0.048	0.305^* * p < 0.05;	0.115	*0.421^ * p < 0.05;**	0.026
IC – Cancellation – Total errors	-0.504^ p < 0.01.	0.006	-0.193^ p < 0.01.	0.324	-0.060^ p < 0.01.	0.760	-0.079^ p < 0.01.	0.689	-0.343^ p < 0.01.	0.074
IC – Cancellation – Total omissions	-0.113^ p < 0.01.	0.566	-0.322	0.094	-0.361	0.059	-0.278	0.152	*-0.412^ * p < 0.05;**	0.029

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[1] Correspondence to G.B.K. MEDINA. E-mail: giovannabkmedina@gmail.com.