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Interactive e-Books to Support
Reading Skills in Dyslexia
Gianluca Schiavo
University of Trento
& FBK
Trento (Italy)
gianluca.schiavo@unitn.it
Vanessa Buson
Centro per i DSA e
le Difficoltà Scolastiche - il Cigno
Verona (Italy)
vanessa.buson@ordinepsicologiveneto.it
ABSTRACT
Developmental dyslexia is the specific learning disability in
reading that affects the ability to read written text. In the current
paper we explore the potential offered by interactive e-book
technologies for supporting reading in people with developmental
dyslexia. An important aspect of interactive e-books, which cannot
be easily achieved with traditional printed media, is the ease of
customizing the text layout in a way that can potentially help those
with reading difficulties. We discuss findings from empirical
studies in psychology and accessibility that identify best practices
for presenting electronic text for readers with dyslexia. Moreover,
given the spreading availability of e-readers and the flexibility
provided by e-books to present content in different ways, we
discuss the opportunities of using interactive e-books for
improving reading skills. We believe that interactive e-books can
be used not only as a support for facilitating reading but also as a
way to develop and enhance the learning abilities of dyslexic
readers.
Categories and Subject Descriptors
H.5.m. Information interfaces and presentation (e.g., HCI):
Miscellaneous.
General Terms
Design, Human Factors.
Keywords
Interactive e-Books; Dyslexia; Learning Disabilities; Reading
Difficulties.
1. INTRODUCTION
Developmental dyslexia is a specific learning disorder
characterized by difficulties in reading acquisition despite
adequate intelligence, conventional education, motivation to learn
and sociocultural opportunity [1]. Dyslexia is characterized by a
distinctive cognitive profile with specific areas of strength and
weakness. People with developmental dyslexia have a preference
for thinking visually rather than verbally and distinctive perceptual
abilities, such as sharper peripheral vision [10]. However, dyslexic
people face challenges in acquiring automaticity in reading. As a
result, reading is slow and error prone, which may influence
reading comprehension and learning from text, with negative
effects on the person’s education and self esteem.
Several theories have been proposed for explaining the cognitive
profile that characterizes dyslexia and its reading impairment (for
a review see [5]). The more prominent theories view the reading
difficulties as a consequence of a specific phonological deficit (the
phonological theory), a deficit in the visual processing of letters
and words (the magnocellular theory) or a coordination
dysfunction (the cerebellar theory). These theories are still widely
debated, but it is well established that developmental dyslexia has
a neurobiological basis with a genetic origin.
Since dyslexia is a developmental disorder [5], it is present at birth
and its effects are lifelong. However, reading difficulties can be
reduced with early intervention that integrates appropriate training
and the support of technology [9]. This paper provides an
overview of technological tools that facilitate reading for dyslexic
users, with a specific focus on interactive e-books. Specifically,
the main contribution is a review of the literature on the text
formatting that should be adopted for facilitating the reading of
digital material, and a discussion on how interactive e-books can
be used in the intervention for reading difficulties.
2. FACILITATING READING THROUGH
TECHNOLOGY
Readers with dyslexia found difficulties in reading text formatted
in traditional ways. The main obstacles that a dyslexic reader
might encounter while attempting to read text include:
Visual recognition difficulties, such as difficulties in recognizing
and identifying words, letters and numbers. Word identification is
also slowed by the effect of visual crowding, a perceptual
phenomenon that refers to the interference of flanking letters on
the recognition of target letters [20 , 18].
Phonological and orthographical difficulties that manifest
themselves as problems in associating written letters (grapheme)
with their specific sounds (phonemes) and in relating the sounds
of language to letters and words with a consequent latency in
naming.
These obstacles have an impact on the reading performance,
leading to:
• Slow and error-prone reading;
• Misspelled words and difficulties in identifying and
remembering complex and new words;
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• Poor reading comprehension;
• Fatigue after reading for a short time.
Moreover, the reading impairment may be accompanied by
difficulties in writing, especially in spelling and handwriting.
However, several studies have demonstrated that specific training
programs and supports, such as changes in the text presentation,
can improve reading performances and content comprehension [9,
5]. In the last decades technology has become an essential tool for
helping dyslexic readers. In fact, the development of strategies for
coping with reading difficulties often relies on the use of
technology: children with dyslexia are encouraged to use
computers for studying, both at school and at home. As a result,
many students with dyslexia use technology such as:
• Software programs that combine OCR (optical character
recognition) and text-to-speech (speech synthesizer),
allowing automatic reading;
• Speech recognition applications to translate spoken words
into text, which support the process of typing and spelling;
• Spell-checkers and spell-predictors for aiding writing and
manipulating text;
• Software for creating concept and mind maps to organize
the information in a visual manner.
Many of these functions are already integrated in most popular
operating systems (across different platforms, from desktops to
tablets and mobiles) and are embedded in many applications
available for the wide audience, such as the voice recognition
technology in Apple’s OS X and iOS, the optical character
recognition provided by Google Drive and the spell-checker
included in office software suits. These functions can be integrated
in interactive e-books and in e-reader applications. In addition to
this, interactive e-books can be used to support the activity of
reading electronic content by manipulating the text formatting.
3. DYSLEXIA-FRIENDLY FORMATTING
Research based on a sample of non-dyslexic readers suggests that
reading content using electronic media, such as e-book readers, is
comparable in terms of reading performance and text
comprehension to reading text presented in traditional paper [11].
Nevertheless, these results might differ when considering readers
with dyslexia: presenting text through an electronic media can
indeed provide a substantial support for this portion of the readers'
population [17].
Empirical evidence from psychological research has demonstrated
the effect that certain manipulations of the perceptual features of
the text may have on speed, accuracy and reading comprehension
in readers with dyslexia [13, 20, 18]. Among e-book applications,
many functions have been proposed for formatting the text in
customized ways. These functions include modification of the
font, rearrangement of the page layout and manipulations of the
dynamics of reading [16, 17].
Guidelines for designing dyslexic-friendly content can be found in
the area of Web accessibility [4, 12]. The British Dyslexia
Association (BDA) [2] has proposed a set of recommendations on
how to present “dyslexia friendly” text, with suggestions for both
digital and printed content. This list contains a considerable set of
recommendations, and suggests good practices for making
material visually accessible for readers with dyslexia. However,
the list is not based on empirical evidence and does not include
recent findings, such as the potential benefit of using short lines of
text [18] and a bigger letter spacing [20]. BDA’s guideline has
been compared with a set of specifications for the visually
impaired users [6]. The comparison suggests that accessibility
recommendations for minimizing visual discomfort and for
facilitating the visual part of the reading process of web pages can
benefit dyslexic, partially sighted and non-impaired users as well
[6 , 12].
The following list (and Table 1) present a summary of
recommendations obtained from [2, 4, 12] and combined with
recent empirical research from psychology and education:
Typeface (i.e. font families): Guidelines suggest the use of
typefaces that facilitate visual distinction between similar
characters: for example, having long ascenders and descenders or
avoiding mirror images for b/d, p/q and u/n. Moreover, sans-serif
typefaces should be preferred. For these reasons, accessible
guidelines recommend typefaces such as Verdana, Arial or
Helvetica. Some typefaces have been specifically designed for
readers with dyslexia (such as the free typefaces Lexia Readable
1
and Open-Dyslexic
2
) but more empirical research is needed to
assess the benefits of using special font families compared to
common ones [15]. Moreover, a study suggested that using
slightly harder-to-read fonts might improve reading
comprehension of short pieces of text in non-dyslexic and dyslexic
students [8]. However, it is not clear whether using slightly
harder-to-read fonts has an effect on long-term outcomes.
Font size: It is recommended to use a relatively big font size,
ranging from 12 and 16 pt. It has been proved that a larger font
size enhances reading speed and accuracy of younger and dyslexic
readers [14]. However, its relation with inter-letter and inter-line
spacing should be considered [18].
Inter-letter and line spacing: It has been found that a bigger
inter-letter spacing facilitates reading in children with dyslexia
[20]. Increasing the letter space of 2.5 pt can indeed improve
reading performances in terms of time and accuracy in dyslexic
children. Furthermore, adding spacing between lines can contrast
the crowding effect especially in weaker readers [18, 17]. A
stronger effect is expected from the co-variation of line and inter-
letter spacing.
Line length: Shorter lines ameliorate reading speed and
comprehension of both digital and paper-based text by helping to
guide attention [18]. Moreover, reading digital material on a small
screen displaying 2.1 words per line, compared to traditional
presentations on paper showing 12 words per line, improves
reading speed and comprehension [17]. Major benefits have been
observed for dyslexic readers with diminished visual attentive
resources. It was hypothesized that short lines might generally
improve reading speed and comprehension by having an effect on
the oculomotor behavior, reducing the probability that crowded
text in locations previously fixated can be perceived [18].
Contrast: Contrast sensitivity has been reported to differ between
dyslexic and non-dyslexic readers. Specifically, it has been
proposed that dyslexic readers might benefit from low-contrast
text, but this hypothesis has received weak or no support form
empirical studies in psychology [13]. However, guidelines suggest
to use dark colored text on a light (not-white) background.
1
Lexia Readable: http://www.k-type.com/?p=520
2
OpenDyslexic: http://opendyslexic.org/
2
OpenDyslexic: http://opendyslexic.org/
Table 1. Summary of recommended formatting styles
Formatting
Recommendation
References
Typeface
Sans-serif typefaces.
No agreement on the best
typeface (Verdana, Arial
or typefaces specifically
designed for dyslexia)
[15, 8]
Font size
Relatively big fonts (size
between 12 and 16 pt)
[14, 20]
Inter-letter
and line
spacing
Letter space of 2.5 pt
[20, 18, 17]
Line length
Short lines
[18, 17]
Background
and text color
(contrast)
Background with light
colors and text in black or
dark grey.
No clear empirical
evidence on the
benefits of these
recommendations
Alignment
Right-aligned text should
be preferred.
Emphasizes
Use bold for emphasizing
Alignment and emphasizes: Right aligned text should be
preferred. Justified text might create large uneven spaces between
words, making reading difficult. Italics and underlined words
should be avoided; it is suggested to use instead bold for
emphasizing. However, there is no strong empirical data in the
literature to support these claims.
It is important to note that inter-subjective variability in setting up
the optimal values for these parameters is high, and it is inherently
difficult to provide defined guidelines for a general profile of users
with dyslexia. It is thus recommended to use a customizable and
flexible environment, where the user, or someone on his behalf
such as the therapist, the teacher or the parent, can adjust the
values and configure their desired text layout.
Moreover, the studies considered in our review are based on
samples with different age ranges: from primary school children
[20, 14, 8], to high school students [17, 18, 13] to adults [15]. It is
thus difficult to claim whether modification on the formatting
could best support preschoolers, young readers or adults with
dyslexia. According to clinical guidelines, dyslexia should be
diagnosed after children have reached the first or second grade but
it might be the case that adapting the text presentation might also
benefit preschoolers and early-learners.
The flexibility afforded by e-books and e-readers to modify text
formats demonstrate the potential in using these technologies to
support reading with dyslexia. A number of applications have
been designed for this purpose, taking into account some of the
parameters presented in our review. These are mainly e-reader
applications (e.g. [16]) and tools for adapting the presentation of
Web content (e.g. [12]). However, reformatting the page might
address the accessibility shortcomings of traditional formatted text
or of printed books, but not necessarily improve the users
experience when reading. In the next paragraph, we outline the
specific benefits that interactive e-books might integrate not only
for making text more accessible but also for developing the
learning skills of dyslexic readers.
4. INTERACTIVE E-BOOKS TO TRAIN
READING SKILLS
As previously discussed, interactive e-books can make reading
easier for those with dyslexia because they permit formatting
changes of the written text. Notwithstanding, the modification
alone cannot address all of the difficulties faced by dyslexic
readers [18].
A promising line of research investigates how e-books and e-
readers can support different methods of reading with respect to
traditional paper-based books, providing solutions that better meet
the cognitive style of readers with dyslexia [3]. For example, an e-
book can be read on portable handheld devices that might have
small screens. Recent studies have provided evidence that using
small-screen devices, such as smartphones, might help people with
dyslexia to read faster and more accurately. It has been found that
reading written content on a 3.5-inch screen using a particular
method of text presentation, so that the text spans only a few
words per line, improves speed and accuracy in students with
dyslexia. This reading method, which can be implemented with
commercially available e-reader software
3
, might limit the
attention span and reduce the demands on visual attention and
memory [18, 17]. Moreover, holding the e-reader in the hand has
proven to positively influence reading performance in dyslexic
readers with reduced attentional resources. Having the text placed
in proximity to the hand might help to maintain the focus of
attention on the text, preventing visual interferences and
improving allocation of attention [18]. Yet, major benefits have
been observed specifically for dyslexic students who struggle most
with phoneme decoding or have limited attentional span.
In addition, interactive e-books are tools that can easily permit the
authoring of the content and its adaptation at different levels (e.g.
formatting, content, modality). These features make e-books
potential tools for supporting the treatment of reading difficulties.
For instance, within a reading skills training program a therapist
can modify the text properties (e.g. formatting, text length,
dynamic of text presentation) of the children’s e-readers for
adapting them to the characteristics of the training. The flexibility
provided by e-books allows the therapist to adjust the parameters
according to the progress achieved as the training program
progresses. The therapist can also monitor the progress and adjust
the text properties remotely using the Web.
Interactive e-books might also be designed to harness adults as
teachers and play partners for children during reading activities.
For example, e-books allow one to record one’s voice while
reading, allowing parents (or the child him/herself) to record the
narration. This is good training for memorizing and practicing
word pronunciation. Moreover, interactive e-books might integrate
functionalities that permit the reader to listen and practice the
recognition of basic units of speech (syllables and phonemes)
within different words. This activity can improve children’s
phonemic awareness: the awareness of the sound structure of
spoken language and one of the fundamental skills for reading.
Computer applications are already available as exercises in the
form of games for training the recognition of phonemes, but the
integration of this function in interactive e-books seems a
promising addition: it has been shown that daily practice in letter-
sound association is effective in increasing phonological
awareness, and that in turn might have a positive impact in reading
3
Such as the iPhone app GoodReader: www.goodiware.com
abilities [9]. It is also worth noting that supporting practices for
students with dyslexia within an educational context can alleviate
difficulties faced by all students, including early readers and
students with learning difficulties. From a developmental point of
view, dyslexia should in fact be considered to be at the lower end
of a continuum of reading ability that also includes poor and
normal reading abilities [19]. Thus, it is likely that beginner or
poor readers might also benefit from resources designed to support
learners with dyslexia.
Another interesting line of research is the use of interactive games
as training tools for basic attentional skills that, in turn, might
affect reading abilities. Recent studies have demonstrated that it is
possible to enhance specific attentional skills in dyslexic children,
such as visuo-spatial processing, using specific video games [7].
These findings open up opportunities for integrating interactive
activities in the form of simple games in e-books, making the
digital reading more engaging and beneficial at the same time.
Taken together, these studies show that there is a great potential in
interactive e-books: they are potentially accessible to users who
have reading difficulties and can be used as tool for developing
and enhancing reading skills. In reaching this goal, it is important
to ground the design of interactive e-books on evidence-based
findings in which cognitive aspects characterized dyslexia and in
which intervention are actually effective. This paper is a
preliminary step in guiding the design of interactive e-books for
readers with dyslexia defining those characteristics that may
improve the quality, the ease and the enjoyment of reading in
children - and potentially also in adults - with dyslexia.
5. REFERENCES
[1] American Psychiatric Association. Diagnostic and statistical
manual of mental disorders: DSM-IV-TR®. American
Psychiatric Pub, 2000.
[2] British Dyslexia Association, 2014. Dyslexia Style Guide.
http://www.bdadyslexia.org.uk/about-dyslexia/further-
information/dyslexia-style-guide.html - Retrieved March,
2014.
[3] Dalton, N.S. Neurodiversity HCI. ACM interactions 20, 2
(2013), 72–75.
[4] De Santana, V.F., de Oliveira, R., Almeida, L.D.A., and
Baranauskas, M.C.C. Web Accessibility and People with
Dyslexia: A Survey on Techniques and Guidelines. Proc. of
W4A ‘12, ACM (2012), 35:1–35:9.
[5] Démonet, J.-F., Taylor, M.J., and Chaix, Y. Developmental
dyslexia. The Lancet 363, 9419 (2004), 1451–1460.
[6] Evett, L. and Brown, D. Text formats and web design for
visually impaired and dyslexic readers - Clear Text for All.
Interacting with Computers 17, 4 (2005), 453–472.
[7] Franceschini, S., Gori, S., Ruffino, M., Viola, S., Molteni,
M., and Facoetti, A. Action Video Games Make Dyslexic
Children Read Better. Current Biology 23, 6 (2013), 462–
466.
[8] French, M.M.J., Blood, A., Bright, N.D., et al. Changing
Fonts in Education: How the Benefits Vary with Ability and
Dyslexia. The Journal of Educational Research 106, 4
(2013), 301–304.
[9] Galuschka, K., Ise, E., Krick, K., and Schulte-Körne, G.
Effectiveness of Treatment Approaches for Children and
Adolescents with Reading Disabilities: A Meta-Analysis of
Randomized Controlled Trials. PLoS ONE 9, 2 (2014),
e89900.
[10] Geiger, G., Cattaneo, C., Galli, R., et al. Wide and diffuse
perceptual modes characterize dyslexics in vision and
audition. Perception 37, 11 (2008), 1745 – 1764.
[11] Margolin, S.J., Driscoll, C., Toland, M.J., and Kegler, J.L. E-
readers, Computer Screens, or Paper: Does Reading
Comprehension Change Across Media Platforms? Applied
Cognitive Psychology 27, 4 (2013), 512–519.
[12] McCarthy, J.E. and Swierenga, S.J. What we know about
dyslexia and Web accessibility: a research review. Universal
Access in the Information Society 9, 2 (2010), 147–152.
[13] O’Brien, B.A., Mansfield, J.S., and Legge, G.E. The effect of
contrast on reading speed in dyslexia. Vision research 40, 14
(2000), 1921–1935.
[14] O’Brien, B.A., Mansfield, J.S., and Legge, G.E. The effect of
print size on reading speed in dyslexia. Journal of Research
in Reading 28, 3 (2005), 332–349.
[15] Rello, L. and Baeza-Yates, R. Good Fonts for Dyslexia. Proc.
of ASSETS ‘13, ACM (2013), 14:1–14:8.
[16] Rello, L., Kanvinde, G., and Baeza-Yates, R. A Mobile
Application for Displaying More Accessible e-books for
People with Dyslexia. Procedia Computer Science 14,
(2012), 226–233.
[17] Schneps, M.H., Thomson, J.M., Chen, C., Sonnert, G., and
Pomplun, M. E-Readers Are More Effective than Paper for
Some with Dyslexia. PLoS ONE 8, 9 (2013), e75634.
[18] Schneps, M.H., Thomson, J.M., Sonnert, G., Pomplun, M.,
Chen, C., and Heffner-Wong, A. Shorter Lines Facilitate
Reading in Those Who Struggle. PLoS ONE 8, 8 (2013),
e71161.
[19] Shaywitz, S.E., Escobar, M.D., Shaywitz, B.A., Fletcher,
J.M., and Makuch, R. Evidence That Dyslexia May
Represent the Lower Tail of a Normal Distribution of
Reading Ability. New England Journal of Medicine 326, 3
(1992), 145–150.
[20] Zorzi, M., Barbiero, C., Facoetti, A., et al. Extra-large letter
spacing improves reading in dyslexia. PNAS 109, 28 (2012),
1145-11459.
