Developmental Dyslexia and Remediation Methods (DDMR)

Developmental Dyslexia and Remediation Methods. Phonological, Visual-attentional and Cross-modal Approaches, a Multicentric Study.

At least, three theoretical frameworks are currently involved in therapeutic research in developmental dyslexia. Each theoretical framework relies on the type of underlying cognitive processes that is viewed as impaired: 1°) phonological processing, 2°) cross modal integration, 3°) visual attention processing. In this controlled and randomized study, three types of computerized training are combined in a multi-factorial remedial approach in 8 to 12 year old children with dyslexia. The main objective is to compare the effectiveness of this remedial approach which combines phonological, visual-attentional and cross-modal training with conventional non-intensive and non-specific rehabilitation

Study Overview

• Status: Completed
• Conditions: Dyslexia, Developmental
• Intervention / Treatment: Other: Phonological; Other: Visual-attention

Detailed Description

Developmental dyslexia is defined as a specific and lasting reading learning disorder. This neurodevelopmental disorder has a severe impact on overall academic learning and behavior, compromises professional and social development and affects 10% of school-age children. As a public health problem, its diagnosis and management are still highly controversial, and the lack of scientific consensus leads to great heterogeneity in clinical practices and post-treatment outcomes. Three therapeutic axes guide research for developmental dyslexia. The first axis is based on phonological deficits. According to the phonological representation hypothesis, a specific deficit in the processing of phonological representations that support the identification of sounds is the cause of the reading disorder. The second axis focuses on attention-related cognitive deficits. According to the visuo-attention deficit hypothesis, a lack of the visuo-attention processing can be viewed as one of the explanatory causes of a dysfunction in letter identification and reading procedures. The third axis aims to achieve automatized processing for letter/sound association. According to the axis, a lack of cross-modal integration in word decoding is altered by a lack of simultaneous association between of a visual and an auditory stimulus.

Many studies attempted to exclusively validate selective remediation according to causal hypotheses that are mainly cross-modal, phonological or visuo-attentional. However, the evaluation of these underlying processing in dyslexic children shows great clinical heterogeneity since most of children simultaneously have the three deficits. Furthermore, no study evaluates the benefits of combining these different trainings on reading skills.

In this controlled and randomized study, three types of computerized training are combined in a multi-factorial remedial approach in 8 to 12 year old children with dyslexia. The main objective is to compare the effectiveness of this remedial approach which combines phonological, visual-attentional and cross-modal training with conventional non-intensive and non-specific rehabilitation.

The secondary objectives will be 1°) to compare the effectiveness on reading skills of a phonological training, versus a visuo-attentional training, 2°) to compare the effectiveness on reading skills from in the order of phonological and visuo-attentional training, 3°) to compare the evolution of performance in comprehension and written production at the end of the three training sessions and 4°) to evaluate child and parents' perception for the outcome of the reading disorder at the end of the training sessions using Likert scales, by means of a questionnaire. The analysis of the results will make possible to evaluate a remedial approach to dyslexia in a clinical context and to better understanding and management of written language disorders.

• Study Type: Interventional
• Enrollment (Actual): 145
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Nice, France
    • Hôpitaux Pédiatriques de Nice CHU-Lenval

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 11 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 8 years old and ≤ at 13 years old;
• Diagnosis of dyslexia validated by performances ≤ at -1.5 standard deviations from the mean on leximetric tests.
• Diagnosis of mixed dyslexia validated by performances ≤ at -1.5 standard deviations from the mean for reading irregular words and pseudo-words in the Evalec© test.
• Performance ≤ at -1.5 standard deviations from the mean for phonological (Evalec©) and visual-attentional tasks in the Evadys© and Sigl© tests.
• Home equipped with a connected computer system for daily training.
• Signing of informed consent by the parents
• The child must be affiliated to a social security scheme

Exclusion Criteria:

• Intellectual retardation, neurological disorders, pervasive developmental disorder;
• Primary sensory deficit;
• Educational deficiencies;
• attention deficit hyperactivity disorder, dysphasia;
• Previous daily phonological or visual-attentional training.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Phonological group	Other: Phonological; Phase 1: intervention without targeted daily training (30 minutes/ week, for 8 weeks); Phase 2: intervention with targeted daily trainingPhonological training (15 minutes/ day, 5 days/week, for 8 weeks)Visuo-attentional training (15 minutes/ day, 5 days/week, for 8 weeks)Cross-modal training (15 minutes/ day, 5 days/week, for 8 weeks); Phase 3: stopping training sessions for 8 weeks
Experimental: visual-attention group	Other: Visual-attention; Phase 1: intervention without targeted daily training (30 minutes/ week, for 8 weeks); Phase 2: intervention with targeted daily trainingVisuo-attentional training (15 minutes/ day, 5 days/week, for 8 weeks)Phonological training (15 minutes/ day, 5 days/week, for 8 weeks)Cross-modal training (15 minutes/ day, 5 days/week, for 8 weeks); Phase 3: stopping training sessions for 8 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
reading skills effectiveness	measure of reading level (reading age) : accuracy (number of errors) and reading time (in seconds) in raw scores and standard deviation	26 weeks to baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
reading skills effectiveness 8 weeks	Measure of reading level : accuracy (error rates) and reading time (in milliseconds) in raw scores and standard deviations	8 weeks to baseline
reading skills effectiveness 18 weeks	Measure of reading level : accuracy (error rates) and reading time (in milliseconds) in raw scores and standard deviations	18 weeks to baseline
orthographic skills effectiveness	count of orthographic (number of errors) in raw scores and standard deviation	26 weeks to baseline
reading comprehension skills effectiveness	measure of reading comprehension level (error rates) in raw scores and standard deviation	26 weeks to baseline
perception of the evolution of the reading disorder	measure the perception of the evolution of the reading disorder by Likert scales : Number of items: 13; Score from 5 to 1; For example, "I like to read" a lot = 5, a lot = 4, normal" = 3, a little = 2, not at all = 1 Another example "it's easy to read", really very easy = 5, I do well = 4, normal = 3, a little difficult = 4, very difficult = 1; The maximum value 5 means that reading and learning are perceived very positively; The minimum value 1 means that reading and learning are perceived very negatively; Results: An increase in scores measured before and after the three training sessions means an improvement	26 weeks to baseline

Collaborators and Investigators

• Sponsor: Fondation Lenval
• Investigators: Principal Investigator: HARRAR-ESKINAZI KARINE, CERTA Fondation Lenval, Children Hospital of Nice CHU-LENVAL

Study record dates

Study Major Dates

• Study Start (Actual): October 25, 2019
• Primary Completion (Actual): December 12, 2022
• Study Completion (Actual): December 12, 2022

Study Registration Dates

• First Submitted: July 18, 2019
• First Submitted That Met QC Criteria: July 18, 2019
• First Posted (Actual): July 22, 2019

Study Record Updates

• Last Update Posted (Actual): September 29, 2023
• Last Update Submitted That Met QC Criteria: September 28, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Neurodevelopmental Disorders; Language Disorders; Communication Disorders; Learning Disabilities; Dyslexia
• Other Study ID Numbers: 19-HPNCL-02

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No