Journal of Child Psychology and Psychiatry **:* (2009), pp ****

doi:10.1111/j.1469-7610.2009.02197.x

Editorial: Virtual Issue Changing concepts of dyslexia: nature, treatment and comorbidity
This topic for this the rst Virtual Issue of JCPP was prompted by a recent independent review, Identifying and teaching children and young people with dyslexia and literacy difculties (Rose, 2009). This review drew on a large evidence-base and took as its working denition that dyslexia is a disorder primarily affecting reading and spelling development, usually associated with impairments of phonological processing, verbal processing speed and verbal short-term memory. It also acknowledged that dyslexia is often accompanied by other features that affect educational attainment (comorbidities), though these are not themselves characteristics of dyslexia. The papers selected for this Virtual Issue have been chosen to reect the evolution of this view of dyslexia, which can be traced from the landmark Isle of Wight study differentiating specic from general reading difculties, reported in the journal in 1975 by Rutter and Yule, through the now classic argument of Stanovich (1994) that questioned the utility of the discrepancy denition of dyslexia, to the contemporary view of dyslexia as a phonological decit (Vellutino, Fletcher, Snowling, & Scanlon, 2004). Against this backdrop, a set of papers is presented, each of which highlights that dyslexia is not a disorder with clear-cut boundaries or with a single cause. Three papers in the selection address the overlap between reading and language impairment: McArthur, Hogben, Edwards, Heath, and Mengler (2000) report that some 55% of children with specic reading disability (SRD) have oral language difculties while 51% of children with specic language impairment (SLI) have SRD. However, the risk of SRD depends upon the nature of the language impairment: Raitano, Pennington, Tunick, Boada, and Shriberg (2004) showed that the pre-literacy outcomes of children with pre-school speech impairment (speech sound disorder; SSD) were relatively good unless their speech difculties were persistent or they had broader language difculties. The nding of a relatively low risk of reading impairment in children with a history of pure speech impairment is reminiscent of earlier work by Bishop and Adams reported in the journal in 1990, which also showed that specic difculties with reading comprehension were more common among children with SLI than the pervasive decits in word-level decoding characteristic of dyslexia. What of children learning to read in languages other than English? It might be supposed that the risk of dyslexia would be less in languages that have more transparent writing systems with fewer irregularities, or in which there are fewer phonological demands because mappings are not at the level of the phoneme (as in alphabetic systems) but involve large units such as syllables or morphemes (e.g., in Chinese). However, Puolakanaho et al. (2007) reported ndings from a study of children at family risk of dyslexia in the highly regular Finnish orthography, showing that 36% of at-risk children are classied as reading disabled at 8.09 years, a gure comparable to that for children learning to read in English. This study also showed that it was possible, with an acceptable degree of accuracy, to use a small set of measures to predict, as early as 3.5 years, who would develop reading problems. These were letter knowledge, rapid naming (a measure of phonological skill) and family-risk status. Extending the method of a family-risk prospective study to Cantonese, McBride-Chang et al. (2008) found that in the second year of kindergarten (45 years), children at family risk were already lagging behind their peers in learning to read Chinese characters and their difculties were associated with impairments in tone detection (a measure of phonological skill) and in morphological awareness. Language delayed children who also experienced reading difculties were characterised by a wider range of cognitive and linguistic impairments including these decits. The increased risk of reading difculties in children from at-risk families is suggestive of a genetic etiology, but since families share environments as well as genes, dyslexia could in principle be the outcome of environmental factors associated with low literacy. Stevenson and Fredman (1990) reported data from a twin study showing that 32% of the variance in reading was accounted for by IQ and social factors including mothers educational level, family size, housing and social circumstances and some aspects of emotional atmosphere at home. However, when IQ was controlled, only two environmental factors had a signicant effect on individual differences in reading; these were family size (a general environmental effect) and maternal criticism (a specic environmental effect that might actually be a consequence of a childs reading failure). This paper also makes clear that even in propitious circumstances and when literacy instruction is good, some children will still experience reading

2009 The Authors Journal compilation 2009 Association for Child and Adolescent Mental Health. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA

Editorial

difculties. Consistent with this, Kovas et al. (2007), using data from the Twins Early Development Study, showed that reading disability is moderately heritable; further, there was some 33% overlap between reading disability and mathematics disability. While much of this overlap was due to shared genetic factors (generalist genes), there were also genetic inuences specic to reading and specic to mathematics. Based on past research, a reasonable hypothesis is that the comorbidity of reading and mathematics disability is due to shared verbal decits (affecting the development of arithmetic competence) and, as intimated above, the comorbidity of dyslexia and SLI is likely due to shared phonological decits. As further papers in this issue illustrate, dyslexia also co-occurs with two quite distinct disorders, attention decit/hyperactivity disorder (ADHD) (Bental & Tirosh, 2007) and developmental coordination disorder (Rochelle & Talcott, 2006), and is associated with a range of other conditions affecting mental health (Carroll, Maughan, Goodman, & Meltzer, 2005). Given knowledge of the nature and characteristics of dyslexia, an ongoing challenge for practitioners who identify dyslexia is the implementation of intervention programmes. Recognising the comorbidity of dyslexia and ADHD, Gittelman and Feingold (1983) were amongst the rst to conduct an early controlled trial to evaluate the efcacy of an 18-week phonics intervention as a treatment for poor readers; in a companion paper in the same volume, they evaluated the impact of medication for ADHD on educational outcome. The ndings were intriguing; the phonics intervention was effective in promoting reading (but not spelling or arithmetic) whereas the medication (methylphenidate) had an impact on arithmetic but not on reading, hinting perhaps at the greater role of executive processes in arithmetic skill. More recently, Hatcher et al. (2006) showed that a 10-week intervention, combining training in oral phoneme awareness and structured book reading plus activities linking the two skills, could be delivered by trained teaching assistants to increase the reading skills of poor readers in Year 1. Extending this work to younger children who enter school with poor speech and language, Bowyer-Crane et al. (2008) showed that the intervention was effective in accelerating reading progress, compared with that of a treated control group who received oral language intervention. A further positive nding was that the oral language programme successfully boosted vocabulary and expressive grammar. The science of dyslexia is well advanced and theory can be used to guide the design of intervention approaches. The papers selected here illustrate the range of research methodologies that have been fruitful to the eld and convergent evidence now presents a strong rationale for considering dyslexia as the behavioural outcome of a number of different

developmental pathways, mediated by a phonological decit. Omissions from the issue include important ndings from longitudinal studies of epidemiological samples (e.g., Fergusson & Lynskey, 1997) and papers representing molecular genetic (Gayan et al., 2005) and neuroscientic (Eliez et al., 2000) approaches.

Margaret J. Snowling

References
* indicates papers cited above but not included in the Virtual Issue selection
Bental, B., & Tirosh, E. (2007). The relationship between attention, executive functions and reading domain abilities in attention decit hyperactivitiy disorder and reading disorder: A comparative study. Journal of Child Psychology and Psychiatry, 48, 455 463. http://www3.interscience.wiley.com/journal/ 117960555/abstract Bishop, D.V.M., & Adams, C. (1990). A prospective study of the relationship between specic language impairment, phonological disorders and reading retardation. Journal of Child Psychology and Psychiatry, 31, 10271050. http://www3.interscience. wiley.com/journal/119367963/abstract Bowyer-Crane, C., Snowling, M.J., Duff, F.J., Fieldsend, E., Carroll, J.M., Miles, J., Gotz, K., & Hulme, C. (2008). Improving early language and literacy skills: Differential effects on an oral language versus a phonology with reading intervention. Journal of Child Psychology and Psychiatry, 49, 422432. http:// www3.interscience.wiley.com/journal/119392243/ abstract Carroll, J.M., Maughan, B., Goodman, R., & Meltzer, H. (2005). Literacy difculties and psychiatric disorders: Evidence for comorbidity. Journal of Child Psychology and Psychiatry, 46, 524532. http://www3. interscience.wiley.com/journal/118735409/abstract *Eliez, S., Rumsey, J.M., Giedd, J., Schmitt, J.E., Patwardhan, A.J., & Reiss, A.L. (2000). Morphological alteration of temporal lobe gray matter in dyslexia: An MRI study. Journal of Child Psychology and Psychiatry, 41, 637644. http://www3.interscience.wiley. com/journal/119004409/abstract *Fergusson, D.M., & Lynskey, M.T. (1997). Early reading difculties and later conduct problems. Journal of Child Psychology and Psychiatry, 38, 899 907. http://www3.interscience.wiley.com/journal/ 119143952/abstract *Gayan, J., Willcutt, E.G., Fisher, S.E., Francks, C., Cardon, L.R., Olson, R.K., Pennington, B.F., Smith, S.D., Monaco, A.D., & DeFries, J.C. (2005). Bivariate linkage scan for reading disability and attentiondecit/hyperactivity disorder localizes pleiotropic loci. Journal of Child Psychology and Psychiatry, 46, 10451056. http://www3.interscience.wiley.com/ journal/118735323/abstract Gittelman, R., & Feingold, I. (1983). Children with reading disorders I. Efcacy of reading remediation. Journal of Child Psychology and Psychiatry, 24, 167 191. http://www3.interscience.wiley.com/journal/ 119540746/abstract

2009 The Authors Journal compilation 2009 Association for Child and Adolescent Mental Health.

Editorial

Hatcher, P.J., Hulme, C., Miles, J.N.V., Carroll, J.M., Hatcher, J., Gibbs, S., Smith, G., Bowyer-Crane, C., & Snowling, M.J. (2006). Efcacy of small group reading intervention for beginning readers with reading-delay: A randomised control trial. Journal of Child Psychology and Psychiatry, 47, 820827. http://www3. interscience.wiley.com/journal/118727278/abstract Kovas, Y., Haworth, C.M.A., Harlaar, N., Petrill, S.A., Dale, P.S., & Plomin, R. (2007). Overlap and specicity of genetic and environmental inuences of mathematics and reading disability in 10-year-old twins. Journal of Child Psychology and Psychiatry, 48, 914 922. http://www3.interscience.wiley.com/journal/ 117960663/abstract McArthur, G.M., Hogben, J.H., Edwards, V.T., Heath, S.M., & Mengler, E.D. (2000). On the specics of specic reading disability and specic language impairment. Journal of Child Psychology and Psychiatry, 41, 869874. http://www3.interscience.wiley. com/journal/119004435/abstract McBride-Chang, C., Lam, F., Lam, C., Doo, S., Wong, S.W.L., & Chow, Y.Y.Y. (2008). Word recognition and cognitive proles of Chinese pre-school children at risk for dyslexia through language delay or familial history of dyslexia. Journal of Child Psychology and Psychiatry, 49, 211218. http://www3.interscience. wiley.com/journal/119392221/abstract Puolakanaho, A., Ahonen, T., Aro, M., Eklund, K., Leppanen, P.H.T., Poikkeus, A.-M., Tolvanen, A., Torppa, M., & Lyytinen, H. (2007). Very early phonological and language skills: Estimating individual risk of reading disability. Journal of Child Psychology and Psychiatry, 48, 923931. http://www3.interscience. wiley.com/journal/117960675/abstract

Raitano, N.A., Pennington, B.F., Tunick, R.A., Boada, R., & Shriberg, L.D. (2004). Pre-literacy skills of subgroups of children with speech sound disorders. Journal of Child Psychology and Psychiatry, 45, 821 835. http://www3.interscience.wiley.com/journal/ 118755382/abstract Rochelle, K.S.H., & Talcott, J.B. (2006). Impaired balance in developmental dyslexia? A meta-analysis of the contending evidence Journal of Child Psychology and Psychiatry, 47, 11591166. http://www3. interscience.wiley.com/journal/118727184/abstract *Rose, J. (2009). Identifying and teaching children and young people with dyslexia and literacy difculties. Available from http://publications.dcsf.gov.uk/ eOrderingDownload/00659-2009DOM-EN.pdf. Rutter, M., & Yule, W. (1975). The concept of specic reading retardation. Journal of Child Psychology and Psychiatry, 16, 181197. http://www3.interscience. wiley.com/journal/119651512/abstract Stanovich, K.E. (1994). Annotation: Does dyslexia exist? Journal of Child Psychology and Psychiatry, 35, 579595. http://www3.interscience.wiley.com/ journal/119266051/abstract Stevenson, J., & Fredman, G. (1990). The social environmental correlates of reading ability. Journal of Child Psychology and Psychiatry, 31, 681698. http:// www3.interscience.wiley.com/journal/119367927/ abstract Vellutino, F.R., Fletcher, J.M., Snowling, M.J., & Scanlon, D.M. (2004). Specic reading disability (dyslexia): What have we learned in the past four decades? Journal of Child Psychology and Psychiatry, 45, 240. http://www3.interscience.wiley.com/ journal/118755314/abstract

2009 The Authors Journal compilation 2009 Association for Child and Adolescent Mental Health.