Reading disorders: causes, symptoms, diagnosis, treatment

Reading is a complex process, in which it is possible to identify motor, perceptual, cognitive and linguistic aspects. Reading is impossible without the ability to distinguish lexical images (letters) and transform them into phonetic (sound) images, catch the syntactic structure of phrases and sentences, recognize the semantic meaning of words and sentences, and also without adequate short-term memory. A reading disorder can be part of a more general speech development disorder or a more specific disorder that is not accompanied by any other speech disorders. There is a close connection between reading skills, solving mathematical problems and the state of oral speech. In children with reading disorders, violations of articulation are observed more often and vice versa. Children who are not able to read experience difficulties in constructing a conversation.

A defect in reading disorders can affect a person's entire life. Difficulties in reading are preserved even in adulthood (especially in men). Having grown up, people with a reading disorder still read and pronounce more slowly than their peers, they rarely receive higher education. Nevertheless, with early recognition and training in special educational programs, compensation for a defect is possible. Surprisingly many artists, famous craftsmen, and even writers (for example, Hans Christian Andersen and Post Flaubert) suffered from reading disorders.

Pathogenesis of reading disorders

Violation of neurophysiological processes. According to modern ideas, reading disorder is associated with underdevelopment of basic language abilities, and not with impaired perception and cognitive functions. Learning to read is possible due to the formation of two systems: first, the lexical (the system of visual images) and, secondly, the phonological (system of auditory images) for unfamiliar words. In children with a reading disorder, the transition from one system to another is difficult. As a result, there is a disconnect between actual reading and understanding of the meaning of what has been read. With the disorder of reading, there are three possible ways of disturbing neurophysiological processes.

1. The ability to decode information is violated, but the understanding remains intact.
2. Decoding is preserved, but understanding (hyperlexia) is broken.
3. Both decoding and understanding suffer.

Most students with a reading disorder have the ability to quickly decode automatically, while reading to oneself may be more secure than reading aloud. Since oral speech is based on the recognition of words, it is also often violated. Studies of visual evoked potentials indicate a pathology of perceptual processes in patients with reading disorders, for example, the inability of visual circles to provide adequate temporal resolution. It is believed that the magnocellular system, including the retina, the lateral geniculate bodies, the primary visual cortex, too slowly processes the visual information, so the words can blur, merge, or "jump out" from the page. The view can "break" from the line, which leads to the omission of words, makes it difficult to understand the text and requires its re-reading. Disorders of visual perception can also make it difficult to communicate with other people, forcing a person to rely on context, repetition, facial expression to understand the meaning of what is happening.

Genetics

Studies indicate a significant accumulation in some families of cases of reading disorders and a high level of concordance in identical twins. Although a model of monogenic inheritance with modification due to external factors is suggested for reading disorders, they are most likely a genetically heterogeneous state.

Neuroanatomical data

Reading disorders may be related to the pathology of development of certain parts of the brain and the violation of the formation of interhemispheric asymmetry. Part of the patients revealed a lack of normal asymmetry of the upper surface of the temporal lobe (planum tempo rale), which can disrupt the formation of writing and oral speech skills. This finding was also confirmed with MRI, which revealed the absence of a normal asymmetry in this region. A similar lack of normal asymmetry is noted in the posterior parts of the brain. In other studies, the phonological aspects of reading disorders are correlated with congenital anomalies of the corpus callosum. Methods of functional neuroimaging also provide important information about the pathogenesis of reading disorders in children. For example, they reveal a lower, than normal, activation of the frontal lobes when performing tests that require significant concentration of attention. PET revealed a change in perfusion in the left temporal parietal region in boys with a reading disorder.

Some of the patients exhibit small cortical malformations, for example, multiple glial scars in the cortex surrounding the Sylvian furrow, ectopic neurons, which probably reflects a violation of the migration of cortical neurons. These anomalies can occur in the prenatal or early postpartum periods.

Diagnostic criteria reading disorder

• A. The ability to read (determined by individual testing using standardized tests for reading accuracy and reading comprehension) is significantly lower than can be expected based on the age of the person, the level of intelligence identified and age-appropriate education.

• B. The disorder indicated in Criterion A significantly violates academic performance or behavioral activity that requires reading skills.
• B. If the sensory organs are disturbed, the difficulty of reading should exceed the level that can be associated with these disorders.

[1], [2], [3]

Treatment of reading disorders

Non-drug treatment

The treatment of reading disorders is based mainly on the use of non-drug methods. All kinds of reading disorders require a strictly individual special educational program based on an evaluation of the neuropsychological profile of the patient, his strengths and weaknesses. Applied methods allow us to use the stored cognitive functions and the possibilities of conceptual thinking through various sensory modalities. It is important to consider that reading disorders are often accompanied by more systemic speech disorders. Apply special corrective techniques, reading aloud, the development of written speech. Various methods for developing reading skills have been developed, but none of them has clear advantages over others.

One of the most commonly used treatments is a synthetic alphabetic multisensory approach, called the Orton-Gillingham method. The pupil develops associative connections between letters and sounds, involving auditory, visual, motor aspects of oral and written speech. As soon as it is possible to develop skills of reading and writing of basic words, attempts are made to construct from them offers. The teaching of reading and writing occurs in parallel with the expansion of speech practice - in order to "bind" the weaker skills to the stronger ones. They also develop the skills of expressive speech and learning. The use of the new microcomputer program has brought promising results in children with speech disorders, improving the recognition of words and decoding skills.

The school atmosphere can significantly alleviate the difficulties associated with this pathology. First, the degree of intervention required should be clarified. Depending on the severity of the disorder, the student may be engaged in the usual class (with some individual work), need daily individual lessons, classes in a special class or must attend a special school for children with learning disabilities. If the child is engaged in the ordinary class, then it is necessary to allocate additional time for written assignments, correct the pronunciation errors (without attracting the attention of classmates), provide the opportunity to take exams orally, and if necessary, release from teaching foreign languages. It is necessary to develop compensatory skills (for example, the ability to use computer programs), talents, hobbies, various forms of leisure - in order to raise self-esteem and bring the child closer to peers. Teenagers are important to help in planning vacations, develop their independence skills.

The school must protect the student from negative labels and insults. Teachers and parents should recognize in time signs of secondary depression, anxiety, feelings of inferiority, which require individual, group or family psychotherapy. Inability to organize their activities, low self-esteem, emotional lability, undeveloped communication skills, characteristic for patients with learning disabilities, require special correction. It is important to take into account that within the family a patient with learning disabilities may suffer from competition with more successful brothers or sisters or from ridicule on the part of younger siblings.

Many parents who feel frustrated, anxious or guilty, need support from the doctor and psychological help. The doctor must assume the duties of the child's attorney in his relationship with the school system. At an older age, you can use special programs in higher education. The activity of social groups, uniting parents and defending the interests of patients, is useful. A number of publications reflect the legal aspects associated with these disorders.

Nootropics - a separate pharmacological class, combining funds that enhance cognitive functions. Nootropics can be useful in the treatment of cognitive disorders, including learning disorders and attention, syndromes associated with organic brain lesions, mental retardation. However, it should be noted that proponents of the use of nootropics often make overly optimistic statements about the effectiveness of these drugs. In this regard, the doctor should strive to protect the patient and his family from scientifically unfounded recommendations. One of the drugs, which probably has some therapeutic effect, is pyracetam. Studies were carried out on various analogues of pyracetam, for example, an example of a cytocaine, but there was no clear evidence of their effectiveness, and none of them was approved for human use. Some of the drugs used in adults for the treatment of memory impairments (eg, hidergin) have not had any significant effect on cognitive function in children. Currently, there is no evidence that any special diet, large doses of vitamins (megavitamins), trace elements, separate nutrition are effective in the treatment of learning disorders or can enhance cognitive functions.

Pharmacotherapy of comorbid disorders

It is important to treat not only primary learning disorders, but also comorbid disorders. Although psychostimulants led to short-term improvement in children with a reading disorder and attention deficit with hyperactivity, they proved ineffective in treating an isolated reading disorder. Nevertheless, it is noted that psychostimulants are able to improve writing in children with learning disability and comorbid attention deficit with hyperactivity. With comorbid anxiety disorder or secondary anxiety caused by a learning disorder, anxiolytics were used, but they did not lead to a significant improvement.

Piracetam. Piracetam - 2-oxo-1-pyrrolidineacetamide - is used to influence the primary defect underlying the reading disorder. Although initially the drug was created as an analog of GABA and was intended for the treatment of motion sickness, it can not be attributed to GABA receptor agonists or antagonists. It is shown that piracetam is able to reduce the level of acetylcholine in the hippocampus, change the content of norepinephrine in the brain, directly affect metabolic processes, leading to an increase in the content of ATP. But whether these effects are relevant to the therapeutic effect of the drug - remains unclear. Pyracetam interferes with the development of posthypoxic amnesia. Thus, its effect on memory can be associated with increased supply of tissues with oxygen. There are also data indicating that piracetam can facilitate the exchange of information between the major hemispheres through the corpus callosum. The study of the effect of piracetam in adults with a reading disorder showed that it improves verbal learning. As the study of visual evoked potentials shows, pyracetam facilitates the processing of visual speech stimuli in the left parietal cortex. According to the multicenter study, which lasted 1 year, piracetam in patients with a reading disorder improved the state of verbal cognitive functions (which was confirmed not only by neuropsychological but also by neurophysiological methods - by analyzing the potentials associated with events), but did not have a significant effect on nonverbal cognitive functions. Another study, which included 257 boys with reading disorders, showed that piracetam increases reading speed, but does not affect reading accuracy or reading comprehension. However, in another, longer multicenter study, piracetam led to some improvement in reading aloud, although it had no effect on the speed of reading and processing information, speech and mnestic processes. In a European study, it was demonstrated that piracetam is able to correct the learning defect associated with the "kindling" mechanism. Pyracetam is a safe drug that does not cause serious side effects.

Thus, the use of piracetamol offers some perspective in the treatment of reading disorders, especially with regard to improving the identification of words and syllables. But the present drug can not be recommended as the only treatment for reading disorders. Further studies are needed to evaluate the effectiveness of piracetam as monotherapy or in combination with speech therapy. Further research is needed on the effect of pyracetam on the processing speed of visual and auditory information. At present, there is no evidence of the effect of pyracetam on concomitant syndromes in patients with reading disorders. Piracetam is approved for use in Europe, Mexico, Canada, but not in the US.