Martin McPhillips

Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial

BACKGROUND Children with specific reading difficulties have problems that extend beyond the range of underlying language-related deficits (eg, they have difficulties with balance and motor control). We investigated the role of persistent primary reflexes (which are closely linked in the earliest months of life to the balance system) in disrupting the development of reading skills. METHODS We assessed the efficacy of an intervention programme based on replicating the movements generated by the primary-reflex system during fetal and neonatal life. A randomised, individually matched, double-blind, placebo-controlled design was used and children (aged 8-11 years) with persistent primary reflexes and a poor standard of reading were enrolled into one of three treatment groups: experimental (children were given a specific movement sequence); placebo-control (children were given non-specific movements); and control (no movements). FINDINGS From an initial sample of 98 children, 60 children, 20 in each group were matched on age, sex, verbal intelligence quotient (IQ), reading ability, and persistent asymmetrical tonic neck reflex. For asymmetrical tonic neck-reflex levels there was a significant (group by time) interaction (p<0.001). The experimental group showed a significant decrease in the level of persistent reflex over the course of the study (mean change -1.8 [95% CI -2.4 to -1.2], p<0.001), whereas the changes in the placebo-control and control groups were not significant (-0.2 [-0.9 to 0.6] and -0.4 [-0.9 to 0.2]). INTERPRETATION This study provides further evidence of a link between reading difficulties and control of movement in children. In particular, our study highlights how the educational functioning of children may be linked to interference from an early neurodevelopmental system (the primary-reflex system). A new approach to the treatment of children with reading difficulties is proposed involving assessment of underlying neurological functioning, and appropriate remediation.

Assistive Software Tools for Secondary-Level Students with Literacy Difficulties

The present study assessed the compensatory effectiveness of four assistive software tools (speech synthesis, spellchecker, homophone tool, and dictionary) on literacy. Secondary- level students (N = 93) with reading difficulties completed computer-based tests of literacy skills. Training on their respective software followed for those assigned to the Assistive Software and the Microsoft Word Control groups. Posttests revealed an improvement for the Assistive Software group on reading comprehension, homophone error detection, spelling error detection, and word meanings. The Microsoft Word Control group also improved on spelling error detection and word meanings, but performed worse on homophone error detection. A Full Control group showed no significant improvements on any of the measures. Overall, results indicate a significant assistive value of the four software tools (from the software package Read & Write Gold, 2002) across several domains of literacy.

Spontaneous attention to faces in Asperger syndrome using ecologically valid static stimuli

Previous eye tracking research on the allocation of attention to social information by individuals with autism spectrum disorders is equivocal and may be in part a consequence of variation in stimuli used between studies. The current study explored attention allocation to faces, and within faces, by individuals with Asperger syndrome using a range of static stimuli where faces were either viewed in isolation or viewed in the context of a social scene. Results showed that faces were viewed typically by the individuals with Asperger syndrome when presented in isolation, but attention to the eyes was significantly diminished in comparison to age and IQ-matched typical viewers when faces were viewed as part of social scenes. We show that when using static stimuli, there is evidence of atypicality for individuals with Asperger syndrome depending on the extent of social context. Our findings shed light on the previous explanations of gaze behaviour that have emphasised the role of movement in atypicalities of social attention in autism spectrum disorders and highlight the importance of consideration of the realistic portrayal of social information for future studies.

Primary reflex persistence in children with reading difficulties (dyslexia): A cross-sectional study

The primary reflex system emerges during fetal life and is inhibited during the first year after birth. Our aim was to examine the effects of persistence of this early neurological system on the attainment of core literacy skills in dyslexic and non-dyslexic poor readers. We assessed the prevalence of a persistent primary reflex in a cross-sectional, representative sample of children (n=739) aged 7-9 years old attending mainstream primary school in Northern Ireland using standardised educational tests, and a clinical diagnostic test for a primary reflex (the asymmetrical tonic neck reflex (ATNR)). Multiple regression analyses, involving all of the sample children, revealed that persistence of the ATNR was significantly predictive of attainments in reading (t=-8.34, p<.001), spelling (t=-8.00, p<.001), non-word reading (t=-16.15, p<.001), and verbal IQ (t=-4.71, p<.001). ANOVA tests revealed that there were no differences between the performance of dyslexic and non-dyslexic poor readers on any of the outcome measures (reading (F(1, 289)=0.51, p=.48), spelling (F(1, 289)=0.02, p=.90), non-word reading (F(1, 289)=0.76, p=.38), ATNR level (F(1, 289)=2.54, p=.11)). Further ANOVA tests revealed that males had significantly higher levels of persistent reflex than females (F(1, 737)=15.21, p<.001), and that children from socially disadvantaged backgrounds had significantly higher levels of reflex than children who were not socially disadvantaged (F(1, 737)=20.84, p<.001). The findings suggest that for many children in mainstream schooling, the attainment of core educational skills may be affected by the persistence of a brainstem mediated reflex system that should have been inhibited in the first year after birth. Furthermore, these findings suggest that dyslexia is not a distinct category of poor reading, and that it may be more valid to term all poor readers as dyslexic irrespective of IQ.

Motor deficits in children with autism spectrum disorder: a cross-syndrome study.

Recent research suggests that children with autism spectrum disorder (ASD) experience some level of motor difficulty, and that this may be associated with social communication skills. However, other studies show that children with language impairments, but without the social communication problems, are at risk of motor difficulties as well. The aim of the present study was to determine if children with ASD have syndrome‐specific motor deficits in comparison to children with specific language impairment (SLI). We used an independent groups design with three groups of children (8–10 years old) matched on age and nonverbal IQ: an ASD group, an SLI group, and a typically developing (TD) group. All of the children completed an individually administered, standardized motor assessment battery. We found that the TD group demonstrated significantly better motor skills than either the ASD or SLI groups. Detailed analyses of the motor subtests revealed that the ASD and SLI groups had very similar motor profiles across a range of fine and gross motor skills, with one exception. We conclude that children with ASD, and SLI, are at risk of clinically significant motor deficits. However, future behavioral and neurological studies of motor skills in children with ASD should include an SLI comparison group in order to identify possible autism‐specific deficits. Autism Res 2014, 7: 664–676.

Motor skill deficits in children with partial hearing

Aim  We examined the effect of partial hearing, including cochlear implantation, on the development of motor skills in children (aged 6–12y).

Comorbid motor deficits in a clinical sample of children with specific language impairment

The aim of the present study was to compare the motor function of a clinical sample of children with specific language impairment (SLI) to a language-matched comparison group that had not been referred for SLI assessment. A typical language comparison group with similar nonverbal IQ was also included. There were approximately 35 children in each group, aged 9- to 10-years-old, and the children completed a range of standardised language, motor and literacy measures. The results showed that the SLI group scored significantly lower than the language-matched and typical language comparison groups on all of the motor and literacy measures. We conclude that language factors alone are insufficient to explain the extensive comorbid motor and literacy deficits shown by the children with SLI in this study. We suggest that the clinical diagnosis of SLI may be influenced by the presence of additional developmental difficulties, which should be made explicit in assessment procedures, and that intervention strategies, which address the broad range of difficulties experienced by children with a clinical diagnosis of SLI, should be prioritised.

The effect of month of birth on the attainments of primary and secondary school pupils

BACKGROUND Previous research has produced conflicting results regarding the effects of season of birth and age-position on cognitive attainments. In Northern Ireland the school year divides the summer season into two providing an opportunity to evaluate the relative contribution of season of birth and age-position effects. AIMS To investigate the relationship between attainment in literacy skills and month of birth for primary and secondary school pupils and to determine the relationship between motor skills and month of birth in primary school pupils. SAMPLE One thousand one hundred and twenty four primary school pupils participated, and results for key stage 3 (KS3) English and GCSE English Language, for 3,493 Year 10 and 3,697 Year 12 secondary school pupils, respectively, were obtained. METHOD Primary school pupils were individually assessed using standardised reading and spelling tests, as well as tests of motor skill. They were also assessed using a standardised group reading test in their class groups. For the secondary school pupils, the results for two year cohorts, in KS3 English and GCSE English language, respectively, were analysed. RESULTS For the primary school pupils there was evidence of both a season of birth and an age-position effect on all of the cognitive measures, particularly in the early years of schooling. There was, also, evidence of a significant age-position effect at both KS3 and GCSE in favour of the older pupils. For the younger primary school pupils there was evidence of significant age-position effects on both motor measures. CONCLUSIONS The findings from the present study suggest that month of birth may be related to both season of birth and age-position effects. These effects may be compounded, particularly in the early years of primary school, when summer born children are youngest in their year, as in England. In Northern Ireland, age-position effects are also evident in secondary school public examination results, which may have implications for long-term life choices.

The use of eye-tracking to explore social difficulties in cognitively able students with autism spectrum disorder: A pilot investigation

Individuals with autism spectrum disorder do not just ‘grow out of’ their early difficulties in understanding the social world. Even for those who are cognitively able, autism-related difficulties continue into adulthood. Atypicalities attending to and interpreting communicative signals from others can provide barriers to success in education, employment and relationships. In the current study, we use eye-tracking during real social interaction to explore attention to social cues (e.g. face, eyes, mouth) and links to social awareness in a group of cognitively able University students with autism spectrum disorder and typically developing students from the same University. During the interaction, students with autism spectrum disorder showed less eye fixation and more mouth fixation than typically developing students. Importantly, while 63% of typically developing participants reported thinking they were deceived about the true nature of the interaction, only 9% of autism spectrum disorder participants picked up this subtle social signal. We argue that understanding how these social attentional and social awareness difficulties manifest during adulthood is important given the growing number of adults with autism spectrum disorder who are attending higher level education. These adults may be particularly susceptible to drop-out due to demands of coping in situations where social awareness is so important.

Motor difficulties and mental health in children who are deaf

The most common type of hearing impairment in children is sensorineural hearing loss, which is caused by functional problems in the cochlea or the auditory pathway to the brain. Research on the developmental impact of deafness has primarily focused on the difficulties that children experience with emergent language and communication abilities, including literacy skills. These are important concerns, as disturbances in areas of core social and cognitive functioning in early life are associated with longer-term difficulties across the lifespan. There is also growing evidence that children who are deaf are at increased risk of motor and balance problems. It has been suggested, due to the close anatomical and functional proximity of the cochlea and the vestibular end-organ in the inner ear, that damage to the cochlea may result in parallel impairments in vestibular functioning and balance (vestibular deficit hypothesis). This has become an important concern over recent decades with the advent of cochlear implantation procedures, although it is still not clear if cochlear implants have a positive or negative effect on motor development in children who are deaf. Recent research on motor development in hearing children has found that children with coordination problems, such as developmental coordination disorder (DCD), are at increased risk of a range of physical and mental health problems, including internalizing problems, such as anxiety and depression. There has been little research, if any, on the possible associations between motor skills and mental health in children and adolescents who are deaf or partial hearing, and so the article by Fellinger et al. is very timely. They found that 57% of children and adolescents (aged 6–16y) with hearing impairment in their sample had significant motor difficulties (scoring in the bottom 5% of a standardized assessment), suggesting high levels of comorbid DCD. They also found that low motor scores were associated with peer relationships and emotional problems on a dimensional measure of psychosocial functioning. One of the major strengths of this study is the selection of the hearing impairment sample, who were drawn from the total first to ninth grade school population (145000 pupils) in Upper Austria over a 2-year period. This is in contrast to most research on hearing impairment, where samples are often based on specific clinical groups. The findings also provide further evidence that children and adolescents with hearing loss are at risk of significant motor and balance problems. In addition, the marked difference that emerged between static and dynamic balance scores is in line with other recent work, and suggests that vestibular deficit theory alone may not be enough to explain the range of motor outcomes for children who are deaf. It is possible that opportunities to engage in social play are restricted, irrespective of vestibular functioning, as a consequence of hearing loss, and that measures of more complex motor behaviours, such as dynamic balance, may be more sensitive to the broader motor profile of children who are deaf. Motor difficulties may also be linked to the increased risk of psychosocial difficulties as part of a vicious circle; language or communication difficulties may disrupt motor development through lack of interactive play, which affects social participation, which leads to problems with peer relations and so on. This echoes the ‘environmental stress hypothesis’ that has been used to explain the basis of social and emotional problems in children with DCD; motor difficulty acts as a direct interpersonal ‘stressor’ affecting interactions with peers and social engagement, which, in turn, negatively impacts on emotional mental health. Importantly, the Fellinger et al. study has highlighted the need for longitudinal work that could unpick the complex links between hearing loss, motor development, and