Developmental Dyslexia Handout PDF

Developmental dyslexia Silvia Brem Developmental Cognitive Neuroscience Department of Child and Adolescent Psychiatry and Psychotherapy University Hospital of Psychiatry Klin...

Developmental dyslexia Silvia Brem Developmental Cognitive Neuroscience Department of Child and Adolescent Psychiatry and Psychotherapy University Hospital of Psychiatry Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 1  Master theses https://www.kjpd.uzh.ch/en/transl-forschung/kog-neuro/praktikum.html Silvia Brem Developmental Cognitive Neuroscience Department of Child and Adolescent Psychiatry and Psychotherapy University Hospital of Psychiatry [email protected] [email protected] Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 2  Quiz: What do you know about Developmental dyslexia? Please fill in the anonymous questionnaire before reading the slides or the article! https://forms.office.com/r/W7cpF71375 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 3  Reading competence and developmental dyslexia Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 4  Reading competence in Europe PISA studies (OECD), every 3rd year, data from 2022 OECD- Durchschnitt Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 5  Reading competence in Switzerland In PISA studies, basic literacy PISA 2000-2022 skills (e.g. reading Prozentanteile leistungsschwacher und leistungsstarker competence) are tested and Jugendlicher im Lesen 30% compared among different OECD countries 25% 14-16% der adults and almost 20% Prozentanteil 25% of adolescents show insufficient reading 15% competence in Switzerland! 10% 5% 0% 2000 2003 2006 2009 2012 2015 2018 2022 PISA-Erhebungen Leistungsschwach Leistungsstark Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] Quelle: OECD – SBFI/EDK, Konsortium PISA.ch 6  How to test reading competence? Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 7  Test your reading!  Groups of two persons (neighbors)  Timer 1 minute, pencil and paper.  You will now see a list of fantasy words. You have one minute time to read aloud as many fantasy words as possible.  Test person: Read aloud the fantasy words as quickly as possible and as accurately as possible. Start on the top left, read each column from top to bottom until 1 minute is over. Don’t watch at the words before starting!  Control person: Use a timer. Stop 1 minute. When you and the test person are ready give a signal to start. Protocol mistakes in reading and write down the last item read within 1 minute.  Important: even though this is a standardized test that is often part of a dyslexia diagnosis, the test run today in this course is not a valid measure! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 8  Test fantasy words aloud, as quickly and accurately as possible tiku tensil tarku stottu silimber kanast Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 9  Test fantasy words aloud: Form A READY? Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 10 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 11  Test fantasy words aloud: Form B READY? Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 12 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 13  Standardized reading test – Salzburger Reading Test-II, Form A & B, pseudowords Adults: Form A Adults: Form B Count the number of correctly read items within one minute  look at the percentile for pseudoword reading. Sandro has read 46 items but Anna has read 81 items from form A in one made 2 mistakes in form B within minute but had 5 items with a mistake: 1 minute: No. correct No. correct items/minute = 81-5=76 items/minute = 46-2=44 Form A  percentile (PR) 53-56 Form B  percentile 5-6 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 14  Diagnosis of developmental dyslexia Not everybody with poor reading competence suffers from developmental dyslexia… Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 15  Developmental learning disorders (reading, writing and/or math) Characterized by significant and persistent difficulties in learning academic skills. The individual’s performance in the affected academic skill(s) is markedly below what would be expected for chronological age and general level of intellectual functioning and results in significant impairment in the individual’s academic or occupational functioning. Developmental learning disorder first manifests when academic skills are taught during the early school years. Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] Source: https://icd.who.int/ 16  Developmental dyslexia: Developmental disorder (ICD-10) Synonyms: Developmental disorder in reading, Developmental dyslexia, Developmental reading disorder, Specific learning disorder w impairment in reading (German: Legasthenie, Lese- und Rechtschreibstörung, Dyslexie) In ICD-10: Specific developmental disorders of speech and language (F80)  Specific developmental disorders of scholastic skills (F81)  Specific reading disorder (F81.0)  Mathematics disorder (F81.1)  Other developmental disorders of scholastic skills (F81.8) In ICD-11: Neurodevelopmental Disorders  Developmental learning disorder (6A03)  6A03.0 Developmental learning disorder with impairment in reading  6A03.1 Developmental learning disorder with impairment in written expression  6A03.2 Developmental learning disorder with impairment in mathematics Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 17  Developmental dyslexia is a neurodevelopmental disorder  Significant limitations in learning academic skills of reading and/or writing resulting in a skill level markedly below what would be expected for age.  Difficulties result in significant impairment in the individual’s academic, occupational, or other important areas of functioning.  Onset of the limitations typically occurs during the early school years Exclusion criteria:  Limitations are not attributable to external factors, such as economic or environmental disadvantage, lack of access to educational opportunities or inappropriate academic instruction.  The learning difficulties are not better accounted for by a Disorder of Intellectual Development or another Neurodevelopmental Disorder or another condition such as a motor disorder or a sensory disorder of vision or hearing. Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] Source: https://icd.who.int/ 18  Diagnostic criteria: Reading and writing disorders  Performance in reading and/or writing tests clearly below average in a standardized test with a significant discrepancy to age, IQ or class norms PR ≤ 7 (1.5 SD)  In the case of clinical or further psychometric evidence for severe difficulties: PR ≤ 16 (1 SD) Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 19  Examples reading and writing in children with dyslexia Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 20  Example text reading test: child in fifth grade SLRT-I Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 21  Example 2: ZLT-II text reading, 5th grade Errors in reading: 16 Time to read (sec): 95 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 22  Example 2, reading competence Reading time in seconds: 95 Errors: 16 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 23  Example spelling problems  Various different types of errors in writing  Children make more errors, there are no „dyslexia- specific“ errors Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 24  Epidemiology of developmental dyslexia Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 25  Epidemiology of developmental dyslexia  The prevalence of developmental dyslexia (reading and or writing) is estimated at ~5-7%  Boys are more often affected than girls: among community samples, the gender ratio of males to females ranges from 1.5:1 to 3:1  Familial risk Women Men dyslexia Kere et al. 2001, J Med Genet Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 26  Prevalence of dyslexia across different languages and writing systems  Similar prevalence across languages (1SD cutoff: ~7%. 1.5 SD: 5.36%)  Similar prevalence across grades: 5-7% Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Yang et al. 2022: https://www.mdpi.com/2076-3425/12/2/240 Bildgebung in der Entwicklung Silvia Brem [email protected] 27  Children with developmental dyslexia often suffer from comorbid symptoms  40-60% of children with diagnoses of learning disorder (dyslexia) show comorbid disorders:  Attention deficit hyperactivity disorder (ADHD): ~20%  Dyscalculia: ~20-50%  Higher risk for depressive (2x) or anxiety (3x) disorders  Negative experiences at school (frustration, anxiety)  Higher school abortion rates, suicidal ideations  Problems in social, and emotional development (psychological problems: internalizing and externalizing) Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 29  Psychopathology in children with learning disorders Visser et al. 2020, https://doi.org/10.3389/fpsyt.2020.00292 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 30  Investigation on psychological/psychiatric symptoms of adolescents with reading impairments Poorly reading adolescents (dyslexia) Control adolescents (no dyslexia) Daniel et al. 2006, Willcut and Pennington et al. 2000, Mugnaini et al. 2009, Willcut et al. 2013, Goldston et al. 2007, Landerl & Moll 2010 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 31  Waiting to fail in dyslexia Dyslexia has a negative impact on the school, job, and social life!  Because the diagnostics is based on a „Waiting to Fail“ approach, i.e. impairments in reading/writing must be present and severe, diagnostics is ususally done after school grade 2 (age 8-9yrs) or often also later: Children fail for two or more years before they eventually get support in school….  Research has shown early risk factors that could be tested already before learning to read in kindergarten, support could therefore start earlier. Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 32  Developmental dyslexia: potential causes for reading problems Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 33  Dyslexia has multifactorial origin Genes Brain development, Cognition Symptoms Network formation impairment phonology Reading: fluency, accuracy, Spech-print association comprehension DCDC2 Working memory Lexical access Spelling …. Environmental factors (family, peers, school etc) Bilder/Fotos Pixabay.com The cause of dyslexia is multifactorial and associated with multiple genes and environmental risk factors. Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 34  Heritability and genes Familial risk: The likelihood of a condition occurring in family members due to shared genes or environment.  Familial risk for dyslexia between 40-60% (Fisher et a. 2002; Raskind et al. 2013)  Similar heritabilities (40-70%) for cognitive skills representing or underlying reading (word reading, spelling, phoneme awareness) (Scerri et al. 2010; Francks et al. 2002; Gayan 2003)  Heritability of reading skills increases with age (from 0.22 at “Heritability refers to the proportion of variance in age 6yrs to 0.82 at age12yrs, Logan et al 2012;  narrowing of a given population that is attributable to genetic influences; other variance components are environmental influence through «standard school curriculum» attributable to environmental influences, gene- and/ or increasing niche selection: environment interplay, or measurement error “ (Peterson and Pennington 2015)  correlation between genotype and environment: e.g. good readers read more and become even better, whereas poor readers avoid reading (“Matthew effect”)  Dyslexia and reading skills are «moderately» heritable Pennington and Peterson 2015. Kere et al. 2001, J Med Genet Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 35  Genetics of Dyslexia: recent genome-wide association studies (GWAS) in large samples Single nucleotide polymorphisms (SNPs) 2274 diagnosed dyslexia cases and 6272 controls SNP with self-reported dyslexia from 51’800 individuals and 1’087’070 controls Giallusi et al. MolPsych 2021 Doust et al. NatGen 2022 SNP: A single nucleotide polymorphism (abbreviated SNP, “snip”) is a genomic variant at a single base position in the DNA. Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 36  Dyslexia candidate genes…. Update in progress!  Replicated linkage studies in dyslexia have resulted so far in nine risk loci (DYX1–DYX9) and around six replicated candidate genes  The most robust candidate genes identified so far include DYX1C1 (15q21), DCDC2 and KIAA0319 (6p22.3), GCFC2 and MRPL19 (2p12), and ROBO1 (Gialluisi et al., 2020) Peterson and Pennington 2015 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 37  Molecular mechanisms potentially implicated in dyslexia  Neuronal migration  Neurite outgrowth  Ciliary biology (Cilia are microscopic hair-like structures on the surface of cells, and their rhythmic movement plays a role in the patterning of early brain development) Rat neocortex: Key dyslexia susceptibility genes, reduced expression due to RNA interference (Kiaa0319, Dcdc2, Dyx1c1):  impaired neuronal migration in the developing cortex of rat embryos Parracchini et al. 2007 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 38  Link between neuronal migration anomalies and behavioural dysfunction Early human studies (Galaburda et al 1985)- «ectopias» Ectopias in language areas of the human  Developmental anomalies reported in four men with brain (anomaly in neuronal migration) developmental dyslexia during lifetime  These ectopias were predominantely in the left hemisphere and perisylvian regions (relevant for language processing) Figure top: Ilustrations from Ramus et al. TRENDS in Neuroscience 2004, data from Glenn D. Rosen; Centanni et al. 2014 & 2016 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 39  Link between genes and behavioural dysfunction: KIAA0319 The rat homolog of human dyslexia candidate gene KIAA0319 Impaired speech sound discrimination in KIA- rats Knockdown of this gene in rats:  Develop largely normal but show subtle changes in brain Decreased speech discrimination performance (Centanni et al. 2014) development and auditory processing of speech sounds (Szalkowski et al. 2013)  Show focal disruptions of neuronal migration (Platt et al. 2013), in similar locations as ectopias described in early human studies (Galaburda et al 1985)  Rats show an atypical neurophysiological response to speech sounds in auditory cortex (Centanni et al. 2013) Average onset and peak latency to consonant  Less effective than typical rats at discriminating phonemes stimuli were later in multiunit recordings from (Centanni et al. 2014) anesthetized KIA− rats (Centanni et al. 2013)  Intensive behavioral training of such rats using speech sounds normalizes the rats’ behavioral performance (Centanni et al. 2014) Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 40  Heritability and explained variance in dyslexia  Recent SNP-based heritability analyses in large GWAS indicated that 20– 25% of the total variance in dyslexia could be explained by common variants (Giallusie et al. 2020, Doust et al. 2022). genes A large proportion of the heritability in dyslexia remains unexplained! environment Explained variance is lower than typical heritability estimates for dyslexia unknown provided by twin studies (40–60%), as usual for “complex traits”:  Part of dyslexia risk may be due to the genetic effects of variants other than SNPs, such as common copy number (CNVs) and rare variants.  Rare CNVs have been implicated in familial forms of dyslexia. For example the candidate gene DYX1C1 was first identified through a rare chromosomal rearrangement which co-segregated with dyslexia in a Finnish family  Dyslexia shows a complex architecture, with multiple genetic and environmental factors playing a role in its etiology! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 41. Genetics of dyslexia  Dyslexia is polygenic involving multiple genes with small effects!  Dozens of genetic variations linked to dyslexia and reading performance: Variations slightly increase dyslexia risk  The identified genetic variations account for 20-25% of dyslexia susceptibility and performance in reading, spelling, and phonological awareness tests  Shared genetic factors explain the co-occurrence of dyslexia with other cognitive and neurodevelopmental disorders.  Variations linked to dyslexia overlap with traits such as verbal intelligence, ADHD, educational attainment.  Some genetic variations correlate with the structure and activity of language-related brain regions, e.g., left superior temporal sulcus (STS) or the left occipito-temporal cortex (visual word form area). Brain surface correlations with genetic variations Doust et al. NatGen 2022 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 42  Dyslexia has multifactorial origin Genes Brain development, Cognition Symptoms Network formation impairment phonology Reading: fluency, accuracy, Spech-print association comprehension DCDC2 Working memory Lexical access Spelling …. Environmental factors (family, peers, school etc) Bilder/Fotos Pixabay.com Alterations in brain structure and function that is often visible even before learning to read! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 43  Brain structure, function and connectivity measure with (functional) magnetic resonance imaging (MRI) Brain structure functional activation Functional & effective connectivity v  Characteristics of brain tissues  Network of brain regions  Functional connectivity e.g. grey matter, fibre tracts activated during a specific task or measures during tasks or rest (white matter), etc. rest Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 44  Spoken and written language processing [ˈdiːˈkatsə ˈfɛŋt Acoustic Phonological ˈaɪnə ˈmaʊ̯s] analysis code Auditory word form Lexical Lexical access selection Visual word Die Visual Orthographic form Katze analysis code fängt eine K A T Z E KATZE Maus Katze Katze Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 45  ectopias Language and reading in the brain Fedorenko Klinik für Kinder- et al. 2024; und Jugendpsychiatrie https://doi.org/10.1038/s41583-024-00802-4 und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 46  Two pathways for reading in the brain Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 47  Dyslexia: Alterations in functional brain activation Precentral gyrus: Compensatory, effortful pronunciation, rehearsal Temporo-parietal cortex: (DYS > CON) Phonological processing, audiovisual integration, attention allocation (CON > DYS) Occipito-temporal cortex: visual word form area Inferior frontal cortex: (VWFA), word form Phonological processing and processing, lexical access access to lexical and (CON> DYS) sublexical phonological units, semantics (CON> DYS) Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 48  Link between genes and variations in brain structure and function in dyslexia  Copy number variant (CNV) carrier status and associated differences in brain structure and function  Deletion carriers show less grey matter and less functional brain activation in the VWFA (fusiform gyrus: red)  Alterations are also found for white matter Structural alterations (grey matter) Functional alterations (activation) Grey matter alterations related to CNV deletion carriers (red = less, Functional brain activation alterations related to blue = more grey matter) CNV deletion carriers during a word reading task Ulfarsson 2017, Translational Psychiatry volume 7, pagee1109 (2017) Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 49  Genes and visual word form area grey matter Brain Genes Prediction of reading outcome at kindergarten age  Variability in the grey matter volume of a core reading region (visual word form area), can be explained by NRSN1 gene variants.  NRSN1-associated grey matter volume of the ‘visual word form area’ achieved a classification accuracy of ~ 73% in literacy- experienced students and distinguished between later dyslexic individuals and controls with an accuracy of 75% at kindergarten age.  cortical plasticity of a region vital for literacy might be genetically modulated, thereby potentially preconstraining literacy outcome! Skeide et al. 2016 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 50  Genes and alterations in brain structure Skeide et al. 2018, Habilitation thesis Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 51  Dyslexia has multifactorial origin Genes Brain development, Cognition Symptoms Network formation impairment phonology Reading: fluency, accuracy, Spech-print association comprehension DCDC2 Working memory Lexical access Spelling …. Environmental factors (family, peers, school etc) Bilder/Fotos Pixabay.com Deficits in basic cognitive skills that are relevant for reading acquisition! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 52  Prereading differences in precursors of reading  Phonological awareness, e.g. rhyming  Letter knowledge  Rapid automatized naming (RAN) of objects, colours, letters…  Differences in brain structure and function Bach & Brem et al. 2013, Brem et al., 2013, Thompson et al. 2015, Maurer et al., 2009, Raschle et al. 2010 & 2012, Specht et al. 2009, Bradley et al. 1983, Schneider et al. 1997, Wagner et al. 1987,Pennington et al. 2001, Puolakanaho et al. 2007, Blachmann et al. 1984, Lervag et al. 2009 Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 53  Dyslexia has multifactorial origin Genes Brain development, Cognition Symptoms Network formation impairment phonology Reading: fluency, accuracy, Spech-print association comprehension DCDC2 Working memory Lexical access Spelling …. Environmental factors (family, peers, school etc) Bilder/Fotos Pixabay.com Complex interaction of genes and environment! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 54  Complex interaction of environment and genes PARENTS Brain reading, spelling, Perceptual sensitivity genes development to linguistic features Phonological skills communication dyslexia K A T Z E Maus-Haus Language environment reading socialisation Parent-child communication Active factors Passive factors Evocative factors Gene-environment Gene-environment Gene-environment correlation correlation correlation Parent’s different Effets of the child’s  Avoidance communication skills different language skills to reading/spelling the parent’s  Selection of communication environment genes Brain Perceptual sensitivity reading, spelling, Phonological skills development to linguistic features communication K A T Z E Maus-Haus dyslexia CHILD Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 55  Dyslexia has multifactorial origin Genes Brain development, cognition symptoms Network formation impairment phonology Reading: Spech-print fluency, accuracy, association comprehension DCDC2 Working memory Spelling Lexical access …. Environmental factors (family, peers, school etc) Bilder/Fotos Pixabay.com Complex interaction of genes and environment! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 56 57 Example timed word reading; child in 5th grade Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 57  Thank you! Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie Bildgebung in der Entwicklung Silvia Brem [email protected] 58