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J. Indian Assoc. Child Adolesc. Ment. Health 2017; 13(2):82-106
Original Article
Correlation between Reading and Spelling Performance of Egyptian Children with
Reading Disorder and their Cognitive and Linguistic Abilities
Neveen Nashaat, Haytham Hasan, Ayman Kilany, Ola Gebril, Suzette Helal, Ghada
Orabi, Mostafa Gaballah, Ehab Abdelraouf
Address for correspondence: Dr. Haytham Hasan, Psychological Medicine Hospital, 5
Ahmed Abdel Nabi St., Nozha El-Gedida, Cairo, Egypt. E-mail:
[email protected]
Abstract:
Background: Proper cognitive and linguistic abilities have a basic role in reading
development. However, the possible role of some cognitive and linguistic abilities in
learning to read especially in Arabic language is still not well studied. Aims: This study
investigated the correlation between the reading (decoding) and spelling performance of
Egyptian Arabic speaking children with reading disorder and their different cognitive and
linguistic abilities in order to determine the possible abilities that have essential role in
reading development. Methods: The participants were 25 Egyptian Arabic-speaking
children with reading disorder (age range: 6.5–10.7 years). The dyslexia assessment test,
Illinois test of psycholinguistic abilities, phonological awareness test and the test of
semantics were used for evaluating the participants’ aptitudes. Results: The disorders in
the abilities reflecting rapid naming, semantics, phonological awareness deficits and one
minute writing were the most common deficits noticed in the participants. The scores of
reading (decoding) and spelling subtests were correlated with the phonological awareness
scores. The spelling performance was further related to verbal working memory.
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Although the rapid naming deficits were the most common among participants, no
associations were found between them and the decoding or spelling abilities.
Conclusions: Phonological awareness and verbal working memory have a role in reading
development in Egyptian Arabic speaking children with reading disorder. The other
examined writing, cognitive and linguistic deficits are most likely to be considered cooccurring disorders with the reading disorder rather than influential on reading.
Keywords: reading disorder, cognition, Arabic language.
Introduction
The Reading disorder, which is also known as developmental dyslexia, is a
multifactorial neurodevelopmental deficit which is characterized by persistent difficulty
in learning to read in people with normal intelligence [1]. The human brain is not
genetically ‘hardwired’ for the reading process. Therefore, proper cognitive and linguistic
abilities have a basic role in reading development. Moreover, the phonological, semantics
and syntactic development was suggested to be related to reading development in
languages other than Arabic [2]. In addition to reading, oral language is suggested to
influence spelling development [3]. However, the relation between some cognitive and
linguistic abilities such as rapid automatized naming (RAN) and phoneme-grapheme
correspondence and their possible role in learning to read is little uncertain [4].
Furthermore, the abilities related to reading development could vary between typically
developing children and those who have reading or spelling disorders [5].
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The relation between language and reading was not adequately investigated in
Arabic which is one of the Alphabetical languages. An alphabetic language is the one
depending on alphabets to represent unique graphemes for the phonemes of that
language. Furthermore, the written Arabic language (the language used for literacy) is
different from the spoken Colloquial Egyptian Arabic which could make the literacy
process challenging [6]. Moreover, the prevalence of reading / spelling disorder in Egypt
is rising. It was estimated to be 12.6 % among third-grade children in 2014 while it was
estimated to be 28/1000 in 1995 which necessitates better understanding of the related
abilities influencing the reading and spelling development for better intervention [7, 8].
Besides, different orthographies were reported to influence reading measures and their
correlation with linguistic abilities [9].
Therefore, the aim of this study was to determine the extent of deficits in the cognitive
and psycholinguistic aptitudes of the Egyptian native Arabic-speaking children with a
reading disorder and to investigate the associations between such abilities and the reading
(decoding) and spelling performance of such children.
Consequently, the possible
abilities that have a role in reading development in Arabic will be identified.
MATERIALS AND MEHODS
Participants
Forty-nine children (36 boys, 13 girls) with reading disorder participated in the present
study. They were recruited from the Learning Disability clinic, Medical Research Centre
of Excellence, National Research Centre, Cairo, Egypt. They were Egyptian native
Arabic speaking children who were enrolled in the national education system. The
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diagnosis of the reading disorder was based on the criteria of DSM-IV-TR [10].
Consents were obtained from the participants’ parents. Verbal assents were obtained from
the participants. The study was approved by the medical research ethics committee of the
National Research Centre, Cairo, Egypt.
Exclusion criteria included presence of sensory deficits, below average intelligence
quotient (IQ), children with EEG abnormalities and presence of comorbid
neuropsychiatric disorders. Ten children with comorbid attention deficit hyperactivity
disorder, eight children with IQ less than 90, three children with EEG abnormalities in
their one hour EEG records, a child with high functioning autism, a child with
neuromuscular disorder and a child with mild to moderate sensory neural hearing loss
were excluded from the study.
The remaining 25 children (18 boys, 7 girls; age range: 6.5–10.7 years; age mean 8.68
±1.14) were enrolled in the study and were assessed using the Arabic dyslexia assessment
test, the phonological awareness test, the test of semantics and the Illinois test of
psycholinguistic abilities.
Tools
• Psychiatric examination using Mini International Neuropsychiatric Interview for
Children (M.I.N.I. Kid) which is a short structured diagnostic interview for DSM-IV
and ICD-10 psychiatric disorders [11]. It was used to exclude other psychiatric comorbidities. The Arabic version was validated with good reliability and validity and it
is used in many studies in Arab Countries [12].
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• IQ assessment using the Arabic version of Stanford-Binet Intelligence Scale, 4th Edition
(SB-IV) to exclude children with below average IQ [13,14].
• The Arabic Dyslexia Assessment Test which has the following subtests: rapid naming,
bead threading, one minute reading, postural stability, phonemic segmentation, two
minute spelling, backward digit span, nonsense passage reading, one minute writing,
verbal fluency and semantic fluency [15,16].
The one minute reading, nonsense
passage reading, and two minute spelling subtests investigate the reading (decoding)
and spelling abilities of the child. The rapid naming, verbal fluency and semantic
fluency investigate the semantics ability of the child at word level which is a verbal
linguistic function. The one minute writing is used for assessment of the speed and
quality of writing. The phonemic segmentation is concerned with deleting syllables or
phonemes and it is a phonological awareness function. The following subtests reflect
some cognitive abilities and some related motor functions: backward digit span (verbal
working memory), bead threading (fine motor coordination) and postural stability
(gross motor control).
• The Phonological Awareness (PA) test was performed to assess the word awareness,
syllable awareness, rhyme awareness, phoneme awareness (at the beginning, the end
and middle of the word), phoneme-grapheme correspondence and sound production
ability. The total score of the test was used to determine the presence of deficits in
phonological awareness which is a verbal linguistic function [17].
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• The Semantics test was used for assessment of semantics at word and sentence levels.
The synonym, antonym and hyponym reflected the at-word level part. The at-sentence
level was assessed by testing the ability to arrange 3-step or 4-step sequencing picture
cards [18]. The semantic abilities are considered to be a part of verbal linguistic
abilities.
• The Illinois test of psycholinguistic abilities (the Arabic version) has the following
subtests: auditory reception, visual reception, auditory association, visual association,
verbal expression, manual expression, grammatic closure, visual closure, auditory
sequential memory and visual sequential memory [19, 20]. The test is applied for
obtaining raw scores for each child in each subtest. The raw scores of each subtest are
converted to scaled scores according to the child’s mental age. The mean of the scaled
scores of the child is calculated. The child’s performance in a subtest is considered
delayed when both (a) and (b) occur: (a). the standard score of this subtest is less than the
mean of the child’s standard scores. (b). the difference between the mean of standard
scores and the standard score of this subtest was more than 6. The auditory association,
verbal expression and grammatic closure are verbal linguistic functions while manual
expression is a non-verbal linguistic function. The cognitive abilities include: auditory
reception, visual reception, visual association, visual closure, auditory sequential
memory, and visual sequential memory. However, an overlap between cognitive and
linguistic abilities could occur as some cognitive abilities depend on language
comprehension and vice versa.
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Data analysis
Data were analyzed using SPSS computer package version 17 (SPSS, Chicago, IL, USA).
The percentage of participants manifested deficits in the reading, writing, spelling,
cognitive and linguistic abilities was determined. The one minute reading, nonsense
passage reading and the two minute spelling subtests of the dyslexia assessment test were
the tests that represented the reading and spelling skills of the participants. Each one of
these three subtests which represented reading and spelling skills was investigated for
correlation with all the remaining subtests used for assessing different abilities of the
participants. Spearman’s correlation coefficient was used to correlate various variables.
When (p) for any item is less than 0.05, it is considered to be statistically significant.
Results
Percent of Participants with Defective Abilities in the Utilized Tests:
Figures 1, 2 and 3 illustrate the percent of participants having deficits of the reading,
spelling, writing, cognitive and linguistic abilities. All participants manifested rapid
naming deficit which makes it the most common deficit manifested by the participants.
Other common cognitive and verbal linguistic deficits that were not addressed to reading
and spelling assessment included verbal fluency, phonemic segmentation, one minute
writing, phonological awareness, semantics (especially semantic fluency, hyponyms and
story sequencing), backward digit span, and auditory reception. None of the participants
manifested manual expression or visual sequential memory deficits.
Figure (1): The percent of participants who manifested deficits in the dyslexia assessment
test
Figure (2): The percent of participants who manifested deficits in the phonological
awareness (PA) test and the semantics test
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Figure (3): The percent of participants who manifested deficits in the Illinois test of
psycholinguistic abilities
Correlations:
The correlations between the one minute reading subtest and the remaining other abilities
of the participants revealed significant correlation only with the phonological awareness
total scores (r=0.520, p=0.008). Other reading, writing, cognitive and linguistic abilities
were not correlated with the one minute reading subtest.
The correlation between nonsense passage reading subtest and the other abilities of the
participants revealed significant correlation only with the two minute spelling (r=0.4,
p=0.03). Other reading, writing, cognitive and linguistic abilities were not correlated with
the nonsense passage reading subtest.
The figures 4,5,6 and 7 illustrate the statistically significant correlation between the twominute spelling subtest and phonemic segmentation, backward digit span, verbal fluency
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and phonological awareness total scores. Other reading, writing, cognitive and linguistic
abilities did not show statistically significant correlation with the two-minute spelling
subtest.
Phonseg=phonemic segmentation
twomspelling=two-minute spelling
Figure (4): Statistically significant correlation between the two-minute spelling and
phonemic segmentation
BWDS=backward digit span
twomspelling=two-minute spelling
Figure (5): Statistically significant correlation between the two-minute spelling and
backward digit span
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Verbfluency=verbal fluency
twomspelling=two-minute spelling
Figure (6): Statistically significant correlation between the two-minute spelling and
verbal fluency
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PA=phonological awareness
twomspelling=two-minute spelling
Figure (7): Statistically significant correlation between the two-minute spelling and
phonological awareness
Discussion
To the extent of the authors’ knowledge this is the first study that was addressed
to investigate the possible relation of certain cognitive and linguistic abilities on the
reading and spelling performance of the native Egyptian Arabic speaking children with
the reading disorder (developmental dyslexia). This would contribute to identifying the
possible abilities that have influential role in the reading development. Furthermore,
identifying the percentage of deficits in these abilities will help to understand such a
complicated disorder and underscore the size of the manifested disorders.
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The manifested deficits
The deficits of rapid automatized naming (RAN) were constantly manifested by the
participants. This could be driven by the commonalities in the brain networks activated
while performing reading and RAN tasks in normal individuals. These networks include
supramarginal gyrus, middle temporal gyrus and cerebellum along with the left inferior
frontal gyrus [21]. In addition, the one minute writing subtest was defective in most of
the participants. The most common noticed abnormality among participants was the slow
speed copying of the required text. This could be attributed to the presence of similar
graphemes in Arabic language. These graphemes differ in the number and position of
dots, such as, the graphemes (‫ث‬،‫ )ت‬which represents the phonemes /‫ ت‬t/ and / ‫ ث‬ᶿ /. They
also differ according to their position in the word (e.g ،‫ ت ــ‬،‫) ــت ـ تــ‬. These criteria together
with their reading disorder make the children rely on their visual processing abilities.
Common co-occurrence among the reading and writing disorders has been reported in
other languages [22]. Yet, the percentage of this co-existence in Arabic was more than
other languages [23] which suggests a language specific difficulty in the writing
performance in Arabic.
Both auditory and visual deficits were noticed among the participants with more
frequent auditory abilities observed. These outputs are in agreement with Gabrieli et al.
[24] who reported common auditory deficits among dyslexic children. These deficits
were explained by problems in rapid auditory processing, visual attention and visual
magnocellular system [24, 25, 26]. Furthermore, syntactic (grammatical) abnormalities
were observed among some participants. These abnormalities could be explained by
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changes in the temporoparietal language areas on the two brain sides. They were
reported to be symmetrical in dyslexic individuals without the normal left-sided
advantage [26].
The correlation outputs
The reading (decoding) ability was only correlated with the phonological awareness
abilities of the participants in this study. Such relation was also reported in Portuguese
which is an alphabetic language [27].
Moreover, low performance in phonological
awareness was reported in children with reading disability and was related to their
reading development [28]. The phonological awareness tasks that involved printed letters
or words were related to superior temporal gyrus, middle temporal gyrus, fusiform gyrus
and left inferior frontal gyrus. On the other hand, the phonological awareness tasks that
involved auditory activities such as rhyming were related to left dorsolateral prefrontal
cortex. Reduced activation of these areas was noticed in dyslexic children [29].
Friend & Olson [30] reported that poor spelling performance was correlated with
poor phonological awareness abilities, which is consistent with the present study. The
spelling abilities for the participants in this study were also correlated with backward
digit span representing verbal working memory (WM) (p=0.006). Beneventi et al. [31]
reported that the verbal WM deficits were attributed to abnormalities of the prefrontal
cortex, the superior parietal cortex and their inter-connections.
Additionally, they
reported that the precentral gyrus was related to phonological processing disorders in the
children with reading disorder as elaborated by functional magnetic resonance imaging.
Consequently, they suggested that both a phonological deficits and a distinct deficit in
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WM could underlie working memory abnormalities in children with reading
disorder. Thus, disorders in phonological processing seem to explain reading, spelling
and working memory deficits in reading disorder and highlight its role in reading
development. The spelling abilities further showed statistically significant correlation
with the nonsense passage reading which confirms the mutual relation between these
abilities. The associations between the two are in agreement with Mohamed et al. [7].
They reported that reading disorder is mostly associated with the spelling disorder.
The spelling abilities were also correlated with verbal fluency in the present
study (p=0.003). Verbal fluency seems to be more related to vocabulary deficit (higher
order process disorder). The relation between spelling performance and verbal fluency
were previously attributed to a semantic orthographic connection deficit [3]. However,
referring this correlation output to a vocabulary deficit should be taken with caution for
two reasons. First, verbal fluency in the present study was assessed by asking the child to
say as many words starting with /s/ as he/she can in a minute. Some participants
produced words not commencing with /s/ but with a similar one (e.g./ᶿ/or /ŝ/). Others
mentioned words with the targeted phoneme within the word or at its end (i.e. not starting
with it). Hence, a phonological awareness deficit could have hindered their ability to
perform this task and could explain the correlation output that was observed. The second
reason is that there was no correlation detected between spelling abilities and other tests
reflecting vocabulary deficit or word finding difficulty including the rapid naming test
which was defective in all participants.
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The absence of correlation between rapid naming scores and the reading and
spelling abilities of the participants could be attributed to the difference in origin of these
abilities. Decoding deficit is one of the lower order process disorders while the RAN is
related to vocabulary deficit which is a higher order process disorder [32]. Moreover,
other higher order process language-based disorders manifested by the participants such
as semantic and syntactic disorders (semantic fluency, synonyms, antonyms, hyponyms,
sequencing, auditory association and grammatical closure) did not show correlation with
their reading or spelling abilities. Therefore, these abilities could be considered as coexisting deficits with the reading disorder.
It is worth mentioning that the relative importance of phonological awareness and
RAN as the basis of reading and spelling abilities would differ between different
languages i.e. non-alphabetic languages and English in comparison to languages whose
orthographies have more consistent letter-sound associations [33, 34]. Unlike English,
Arabic language mostly has consistent phoneme-grapheme correspondence. There are
few exceptions such as Shadda /‫ﱢ‬/ (a diacritic mark) and Lam Shamsiya (a definite article
which proceeds words starting with certain letters) [35, 36]. Therefore, the role of
phonological awareness is most likely to have the basic influence on reading
development in Arabic. In accordance with the present study, Vaessen et al. [37] and
Ziegler et al. [38] highlighted the role of phonological awareness in reading performance
and limit the role of rapid naming in the reading abilities. On the contrary, the significant
correlation outputs of this study disagree with Wimmer et al. [39] who argued that in
consistent orthographies RAN is the predominant predictor of variations in reading
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ability whereas phoneme awareness and letter–sound knowledge are much less
important. A possible explanation for this disagreement is that their notion stemmed
from longitudinal studies on German and English which are less transparent than Arabic.
In addition, our interpretations disagree with Georgiou et al. [40] who reported that
neither RAN nor phonological awareness was related to reading development in Greek
which has consistent orthography.
Conclusions: The decoding and spelling abilities are strongly related to the phonological
awareness performance in Egyptian native Arabic-speaking children with reading
disorder. Moreover, verbal working memory has a role in their spelling performance.
Accordingly, the phonological awareness and the verbal working memory are suggested
to have an essential role in the reading development in Arabic. Other cognitive, writing
and linguistic deficits could be considered associations or co-occurring disorders with the
reading disorder rather than to have an influential role. Nevertheless, deficits in these
abilities should be screened among children with reading disorder and should be targeted
in the remediation plan for such children.
Conflict of Interest: The authors declare that they have no competing interests.
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Neveen Nashaat, Doctoral degree, researcher of phoniatrics; Haytham Hasan, Doctoral
degree, researcher of psychiatry; Ayman Kilany, Doctoral degree, researcher of
neurology; Ola Gebril, Assistant professor of human genetics; Suzette Helal, Assistant
professor of neurology; Ghada Orabi, M.Sc. degree, assistant researcher of phoniatrics;
Mostafa Gaballah, M.Sc. degree, assistant researcher of pediatrics; Ehab Abdelraouf,
Professor of pediatrics, head of research on children with special needs department,
Psychological Medicine Hospital, 5 Ahmed Abdel Nabi St., Nozha El-Gedida, Cairo,
Egypt.