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Content uploaded by Ângela Maria Vieira Pinheiro
Author content
All content in this area was uploaded by Ângela Maria Vieira Pinheiro on Oct 31, 2019
Content may be subject to copyright.
1 Pontifícia Universidade Católica de
São Paulo (PUC-SP), Programa de
Pós-Graduação em Fonoaudiologia,
São Paulo, São Paulo, Brasil.
2 University of Montreal, Institut
Universitaire de Gériatrie de Montréal,
École d’orthophonie et d’audiologie,
Montreal, QC, Canada.
3 Hospital de Olhos de Minas Gerais –
Dr. Ricardo Guimarães, Laboratório de
Pesquisa Aplicada à Neurociências da
Visão (LAPAN), Belo Horizonte, Minas
Gerais, Brasil.
4 Universidade do Porto, Faculdade de
Psicologia e Ciências da Educação,
Porto, Porto, Portugal.
5 Universidade Federal de Minas Gerais,
Programa de Pós-Graduação em
Psicologia: Cognição e Comportamento,
Laboratório de Processos Cognitivos
(LabCog), Belo Horizonte, Minas Gerais,
Brasil.
Source of support: This study was
financed in part by the Coordenação de
Aperfeiçoamento de Pessoal de Nível
Superior -Brasil (CAPES) - Finance Code
001.
Conict of interests: Nonexistent
Association between auditory temporal and
visual processing in reading skill
Ana Carla Oliveira Garcia1,2,3
https://orcid.org/0000-0003-4664-0073
Douglas de Araújo Vilhena3,4,5
https://orcid.org/0000-0003-2670-7963
Márcia Reis Guimarães3
https://orcid.org/0000-0002-5475-5375
Ângela Maria Vieira Pinheiro3,5
https://orcid.org/0000-0002-5852-4320
Teresa Maria Momensohn-Santos1
https://orcid.org/0000-0003-4751-0721
Received on: May 23, 2019
Accepted on: September 12, 2019
Corresponding address:
Ana Carla Oliveira Garcia
Rua Itapira 219, Jardim Mesquita
CEP 12327-689 - Jacareí, São Paulo,
Brasil
E-mail: anacarlagarciausa@gmail.com
ABSTRACT
Purpose: to verify whether students screened with altered auditory temporal proces-
sing are more likely to present altered visual processing.
Methods: the sample consisted of 68 children, aged from 9 to 12 years, 53% males,
from the 5th and 6th grades of a public school. All children with alterations in the audio-
logical or ophthalmological evaluation were excluded. The Duration Pattern Test (scre-
ening for auditory temporal skill), the Reading Perceptual Scale (visual stress symptom
questionnaire and colored overlays selection) and the Rate of Reading Test (number of
words correctly read per minute) were used. Appropriate statistical tests were applied
adopting the significance level lower than 0.05.
Results: participants screened with abnormal auditory processing had higher visual
stress symptoms and lower reading rate, with a significant and moderate effect
(p< 0.05; d< 0.71), when compared to their peers with normal auditory proces-
sing. Among the children with altered Duration Pattern Test, 58% improved the rea-
ding rate with the use of colored overlays, whereas 29% did so in the control group
(Odds Ratio = 3.4, p = 0.017).
Conclusion: children screened with altered auditory temporal processing presented a
three times higher possibility of association with visual processing alterations, due to
shared magnocellular system
Keywords: Reading; Learning; Vision; Hearing; Auditory Perception
Original articles
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Rev. CEFAC. 2019;21(5):e6119 http://dx.doi.org/10.1590/1982-0216/20192156119
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INTRODUCTION
For the last 20 years, progress in neurosciences
and cognitive psychology have contributed to a better
understanding of neuronal mechanisms involved in the
act of reading. Reading is a complex multisensorial
process, which involves visual perception/processing,
visual memory, visual-auditory association, auditory
memory/recognition, phonological processing, oral
expression, and verbal processes1-3.
An essential aspect for the prociency in reading
is the temporal sequence processing of auditory and
visual information, which enables the forming of precise
representations of the order of sounds in a word
and the visual sequencing of letters4-8. The auditory
temporal processing may be dened as the perception
of change in sound within a specic time period; i.e., it
refers to the ability of noticing or distinguishing auditory
stimuli presented in quick succession9. As for the
temporal processing of visual information in reading, it
depends on the perception of movement and contrast,
the preservation of spatial order for the quick recog-
nition of the unchanging strokes of the letters that form
the words, and the comparison to the images previ-
ously stored in our memory (visual vocabulary). Just
as the dynamic auditory processing is related to the
perception of speech and to phonological awareness,
the dynamic visual processing is related to orthographic
skills, and both processes are predictive of reading and
writing skills development4.
Both the auditory and the visual sequencing depend
on the properties of the transient system in the brain,
which is mediated by neurons of the magnocellular
system, with quick temporal processing and low
spatial processing10,11. The well-succeeded sequencing
depends on the timing accuracy of auditory and visual
sensory inputs, whose neural pathways are integrated
into the thalamus by the medial and lateral geniculate
nucleus, respectively. The dorsal magnocellular system
mediates the temporal sequencing as it registers the
amplitude and the order of the changes in attention of
eye movements while inspecting each word11. It plays
a vital role in controlling the driving of visual attention
to reading, which contributes to the quick and precise
recognition of each sequential letter within a word8.
This system is also important for detecting changes in
lighting and movements, and controlling visual search,
among others.
Part of the dyslexics has a decit in the magnocel-
lular system, characterized by decreased sensibility to
contrast in low spatial frequency with high temporal
frequency4,12-14. The magnocellular system estab-
lishes the time each eye xation lasts, in addition to
the direction taken by the saccadic eye movements
in between pauses. A difculty in the visual magno-
cellular system leads to a decreased stability of eye
xation on the letter or word, consequently causing
progressive discomfort and visual stress. The foveal
analysis of static visual acuity, mediated by the neurons
of the parvocellular system (which has low temporal
processing and high spatial processing), doesn’t have
enough information about reading uency or the quality
of dynamic visual processing.
Visual processing disorders cause a series of
symptoms and signs15,16, either isolated or in comor-
bidity with development disorders, as in dyslexia17,18,
attention decit hyperactivity disorder19, Tourette
syndrome, and autism spectrum disorder20. The
treatment with colored overlays and lters improves
reading performance and reduces the prescription of
medications inpatients whose restlessness and lack
of attention result from avoidance behavior due to
symptoms of visual stress adaptation to varied lighting
conditions15,21-25.
In order to investigate the association between
visual and auditory processing, this study aims to verify
whether students screened with alterations in auditory
temporal processing are more likely to present visual
processing disorders, when compared to their peers
with normal auditory processing.
METHODS
Participants
Only the children who signed the Informed Assent
Form and whose parents or adults responsible for them
signed the Informed Consent Form participated in the
research, as warranted by the National Health Council
Resolution 466/12. Data collection took place after the
approval by the Research Ethics Committee of the
Pontical Catholic University of São Paulo - PUC-SP,in
accordance with the Certicateof Presentation for
Ethical Consideration (CAAE, as abbreviated in
Portuguese) number 52510115.9.0000.5482.
This is an observational cross-sectional study. The
sample was composed of 68 children, aged from 9 to
12 years - 11.2 years in average (± 0.7 years), 53%
male, properly enrolled in the 5th (n = 24) and 6th (n
= 44) grades of Elementary and Middle School at
a public institution in the city of Jacareí, state of São
Paulo. In the School Performance Evaluation System
Garcia ACO, Vilhena DA, Guimarães MR, Pinheiro ÂMV, Momensohn-Santos TM Auditory temporal and visual processing
doi: 10.1590/1982-0216/20192156119 | Rev. CEFAC. 2019;21(5):e6119
Auditory temporal and visual processing | 3/10
of the State of São Paulo (SARESP, its Portuguese
acronym), the school at issue obtained a prociency
level superior to the goal established by the São Paulo
State Department of Education. As inclusion criteria,
all the children without central visual or auditory altera-
tions participated in the research. Fourteen children
(not counted in the sample) were excluded due to
presenting altered ophthalmic evaluation (e.g., having
myopia, astigmatism, hyperopia, low vision, or wearing
glasses), or audiological evaluation (e.g., threshold
higher than 25 dB HL in a 250-to-4,000-Hz frequency
range, in or both ears; or, with alteration in the acoustic
immittance with type B or C curve). The full description
of the sample and the evaluation to which they were
submitted, including the description of the instruments
and procedures, are available in Garcia, Momensohn-
Santos and Vilhena23.
Instruments
The Duration Pattern Test (DPT)26 was used to
identify auditory temporal orderingskill. It consists of
ute musical sound stimuli (melodic tones) of long
(2,000 ms) and short (500 ms) duration. They are
applied in ten sequences of three stimuli, and ten
sequences of four stimuli, with xed frequency of 440
Hz and interstimulus interval of 6 milliseconds. The tests
were carried out binaurally in a sound booth, with supra-
aural headphones at 50 dB ns. The clinical two-channel
audiometer, brand Maico MA 42, was used, along with
TDH-39P headphones, brand Telephonics, attached to
a computer, by means of an interface cable, from the
headphone plug to one of the CD/tape plugs of the
audiometer.
The Reading Perceptual Scale (IRPS)27 is a set of
evaluations used as a visual processing disorder risk
indicator. It’s composed of: i) a questionnaire with 32
items on difculty and discomfort while reading (Table
1); ii) tasks that intensify visual stress (e.g., Figure 1a);
and, iii) a selection of colored overlays (Figure 1b). The
IRPS questionnaire on reading difculty and discomfort
has positive and moderate correlation (r = 0.69, p<
0.001)23. The colored overlays are acetate sheets in ten
tones, used over the text since the 1980s to improve
reading performance and to increase visual comfort of
children and adults with symptoms of visual stress in
reading23,25,28.
Table 1. Reading Perceptual Scale Difficulty and Discomfort Questionnaire
Difculty Questionnaire Discomfort Questionnaire
1. Do you accidentally skip lines or phrases?
2. Do you lose track when reading?
3. Do you mistake words?
4. Do you skip words unintentionally?
5. Do you read the same line over several times?
6. Do you confuse words from the top or bottom line?
7. Do you avoid reading in silence and aloud?
8. Is your reading slow or interrupted?
9. Are you bothered by white or bright pages?
10. Do you look away to the distance, rest or make pauses?
11. Do you get anxious, restless or easily distracted?
12. Do you feel that reading gets progressively harder?
13. Do you use a bookmark or your finger?
14. Is it hard for you to understand what you read?
15. Is it hard for you to remember what you’ve read?
16. Do you have to make an effort to keep on reading?
1. Do your eyes bother you?
2. Do your eyes get red or teary?
3. Do they hurt or burn?
4. Do they get dry, itchy or gritty?
5. Do you rub your eyes, or around them?
6. Do you get tired or sleepy?
7. Does your head bother you?
8. Do you have headaches?
9. Do you feel dizzy?
10. Do you feel stomach sick, or have stomachaches?
11. Do you open your eyes wide?
12. Do you squint or frown?
13. Do you blink too often?
14. Do you approach or move away from the page?
15. Do uorescent lights bother you when you read?
16. Is it more difficult to read under white light?
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repeated in 20 lines, adding up to 300 words. It’s
printed in reduced font (size 9) and single line spacing,
thus diminishing the scope of saccadic eye movement
and increasing visual effort. Each list is read aloud for
up to one minute.
The Rate of Reading Test (RRT)29 was used to
measure the effect of the colored overlays on the
reading rate, and to screen the participants with visual
processing disorder. It is composed of ve different
lists, one for training and four for testing (e.g., Figure 2).
The lists are composed of 15 high frequency words30
(a)
(b)
Figure 1. (a) Example of visual stressor from the Reading Perceptual Scale; (b) Example of colored overlays
lua fada mar vida time pé ar rei dia já rua pão bala ovo uva
mar rei pé ar rua fada uva ovo pão bala lua vida dia time já
ovo bala dia mar pão lua já vida fada ar time rua rei uva pé
rua pão uva ovo vida ar pé rei bala dia lua já fada mar time
vida fada lua dia rei time rua já mar pé uva ar bala pão ovo
uva dia rei time bala já ar pão pé fada vida ovo lua mar rua
já vida lua ovo ar pé dia time bala uva mar rua rei fada pão
rei uva bala já fada vida mar pão rua lua ovo dia time pé ar
pé fada time mar dia rua lua rei ovo bala já pão ar vida uva
ar ovo rua bala rei já time dia vida pão uva fada pé lua mar
lua fada mar time vida pé ar rei dia já rua pão bala ovo uva
mar rei pé ar rua fada uva ovo pão bala lua vida dia time já
ovo bala dia mar pão lua já vida fada ar time rua rei uva pé
rua pão uva ovo vida ar pé rei bala dia lua já fada mar time
vida fada lua dia rei time rua já mar pé uva ar bala pão ovo
uva dia rei time bala já ar pão pé fada vida ovo lua mar rua
já vida lua ovo ar pé dia time bala uva mar rua rei fada pão
rei uva bala já fada vida mar pão rua lua ovo dia time pé ar
pé fada time mar dia rua lua rei ovo bala já pão ar vida uva
ar ovo rua bala rei já time dia vida pão uva fada pé lua mar
Figure 2. Example of one of the lists from the Rate of Reading Test
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Auditory temporal and visual processing | 5/10
The results are given in numbers of words correct
per minute (WCPM) and in the percentage of reading
rate improvement when using the colored overlay.
Improvement of at least ≥5% in reading rate with the
use of colored overlays was considered as a criterion
to screen the children with visual processing altera-
tions. The index of ≥5% is predictive of the sustained/
prolonged use of colored overlays (predictive validity,
sensibility of 60 to 73%)31-33.
Data analysis
The IBM SPSS Statistics (version 21.0, Chicago,
Illinois, USA) was used for all data analysis. For evalu-
ating the association between variables, the chi-squared
test of independence and odds-ratio calculation was
applied. In order to establish the clinical signicance of
the differences, Cohen’s d of 0.2 represents small effect
size; 0.5, medium effect; and 0.8, large effect. P-value
inferior to 0.05 was considered statistically signicant.
RESULTS
In the Duration Pattern Test, 42 (61.8%) participants
presented normal results, whereas the other 26 (38.2%)
were screened with auditory temporal ordering skill
(Table 2). The sample classication of the DPT was
used in the analysis of the IRPS and RRT to identify the
association between the auditory processing and the
visual processing. Participants with alterations in the
DPT, when analyzed taking the IRPS reading difculty
and discomfort questionnaire as a reference, reported
more visual symptoms (11.9 ± 7.5) than the group
with normal DPT (8.6 ± 5.8) (F(1.66) = 4.3; p = 0.043;
d = 0.49).
Participants with altered DPT, when evaluated by
the RRT, presented lower reading rate (RRT = 85.6 ±
20.0 words correctly read per minute), when compared
to the group with normal DPT (RRT = 100.0 ± 20.6
WCPM) (F(1.66) = 8.1; p = 0.006; d = 0.71). In the
RRT evaluation, 27 (39.7%) of the students presented
improvement of reading rate with the use of colored
overlay (improvement of at least ≥5%), whereas 41
(60%) didn’t present improvement (performance <5%).
Among the children with alteration in the DPT, 58%
improved the reading rate with the use of the colored
overlay, while 29% of the control group presented
improvement (Table 2). That is, students who
presented alteration in the DPT were three times more
likely to improve their reading rate with the colored
overlay, when compared to their peers with normal DPT
(Odds Ratio = 3.41; CI = 1.22 – 9.5; chi-square = 5.69;
p = 0.017).
Procedures
The data collection took place at the school itself
and at the Integrated Medical Service of the Public
Health Care System. The evaluations were carried out
individually, at a time not interfering with school content
learning, in a separate room, apart from the ongoing
trafc of people and other noises. All the participants
were examined by an ophthalmologist, with the
purpose of checking visual acuity limitation, indicated
by refractive error, which could cause reading dif-
culty due to loss of sharpness. Those who presented
ophthalmic alteration were excluded from the study and
referred for appropriate guidance and therapeutic inter-
vention. Initially, a rapport was established in order to
achieve a good interaction with the participant.
The evaluation of auditory temporal ordering skill,
by means of the DPT, was carried out always by the
same speech-language-hearing therapist, so as to
avoid deviations and differences in the collection proce-
dures. The participant was asked to verbally name the
sequence of tones they heard. The number and the
percentage of right answers were registered; an answer
was considered wrong when the sequence of sounds
presented was inverted. For children nine years old and
over, the normality standard for the three-sound DPT is
100% of right answers; as for the four-sound, it’s 90% of
right answers.
The participants answered the IRPS questionnaire
(Table 1), which includes questions on reading lines,
omitting words or lines, losing track, poor handwriting,
inefciency in copying from books or from the board,
rubbing the eyes, blinking excessively, tearing, shading
the eyes, aversion to strong lights, among others.
The score of the items was given according to the
frequency with which it occurred during reading activ-
ities: frequently (1 point), sometimes (o.5 point), never,
or couldn’t answer (0 point). Then, they were submitted
to visual effort tasks, in which discomfort is progressive
until visual stress is manifested; its mitigation was
induced through the use of one or even two colored
overlays, presented in a patterned and sequential
manner.
In the application of the RRT, the child read each
word aloud, sequentially, from left to right, as fast
as possible, in each of the ve lists. The training list
is applied for the participant to get used to reading
decontextualized words in sequence. The rst list of the
test was overlaid with the self-chosen colored overlay,
followed by the second and third lists, read without
an overlay, and the fourth list, read with the overlay
again (ABBA design for controlling practice effect).
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Table 2. Frequency and percentage of students in the classifications of screening for auditory processing (Duration Pattern Test, DPT)
and for visual processing (Rate of Reading Test, RRT)
Visual (RRT) Total p value
Altered Normal
Auditory
(DPT)
Altered Frequency 15 11 26
0.017
% in the altered DPT 57.7% 42.3% 100.0%
Normal Frequency 12 30 42
% in the normal DPT 28.6% 71.4% 100.0%
Total Frequency 27 41 68
% in total sample 39.7% 60.3% 100.0%
Key: DPT: Duration Pattern Test; RRT: Rate of Reading Test; Auditory Processing (Altered = accuracy lower than<100% in the three sounds, and<90% in the four
sounds); Visual Processing (Altered = improvement of at least ≥5% in reading rate with the use of colored overlay; Normal = difference<5% in reading rate). Source:
elaborated by the authors.
DISCUSSION
The results obtained from this study, based on
screening instruments, demonstrate that there is a
association between auditory processing and visual
processing. About 38% of the students presented alter-
ation in screening for auditory temporal ordering skill,
which is the ability to distinguish correctly the order
in which an acoustic signal occurs in a specic time
period. It was veried that these children with auditory
alteration had more visual stress symptoms, lower
reading rate, and greater chances of improving reading
speed with the use of colored overlays, when compared
to the control group. That is, children screened with
alteration in the auditory temporal processing probably
have a decit in visual processing as well.
These results are coherent with the decit in the
visual magnocellular system in dyslexics. Pammer and
Wheatley14 veried that a group of 21 dyslexics had
a poorer performance in detecting a visual stimulus
selective of the magnocellular system, when compared
to 19 readers of the control group (F(1.38) = 13.6,
p< 0.001), with diminished sensibility in comparison
with the standardized age cohort. In the study by Flint
and Pammer12, illiterate adults obtained the same perfor-
mance as that of normal and semi-illiterate readers
in temporal and spatial tasks specic of the visual
magnocellular system, and these three groups had a
better performance than the group of dyslexic readers.
The authors conclude12 that this functional failure of
the dorsal visual pathway in dyslexia is probably not
a consequence of the lack of reading; they point to a
causal role of the magnocellular processing, instead.
The evaluation of the abilities that sustain learning
to read, as well as of the disorders that may affect its
prociency becomes more and more important by
the day. It was veried that the DPT, the IRPS and the
RRT are important resources in the clinic to screen
children suspect of presenting alteration in the auditory
and visual processing. The RRT makes it possible to
measure the number of words correctly read per minute
(reading rate), and it’s sensitive to identify the effect of
colored overlays, in a quick and simple way, at low cost.
The RRT has a low degree of linguistic processing, as
it requires high frequency nouns, with neither syntactic
nor semantic relation between them, to be recognized
and read aloud. The non-requirement of understanding
for the word, sentence and text (textual micro- or macro-
structure) reduces the access to the semantic system
and high-order cognitive components. These factors, if
not controlled, may increase variability in reading rate
score. Furthermore, the reduced structural spacing
conguration between the lines in the RRT is similar
to medium spatial frequency sinusoidal line patterns
(2 to 5 cycles per degree), which are recognized as
inducing triggers of visual perceptual distortions and
discomfort34.
Evans, Allen and Wilkins15 consulted 22 experi-
enced practitioners about visual stress diagnosis
indicators. They consider that there should be present
at least threeof six typical symptoms: i) words move
when reading; ii) words merge together; iii) patterns
or shadows in the text (e.g., rivers); iv) text seems to
stand out in 3-D above the page; v) words or letters
fade or darken; and, vi) discomfort with certain articial
lights and icker. Moreover, there must be present at
least two of three investigation signs: i) voluntary and
spontaneous use of colored overlays for three months
or more; ii) improvement in reading rate ≥15% with the
use of overlays; and, iii) visual difculty and discomfort
with medium spatial frequency sinusoidal grating.
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Auditory temporal and visual processing | 7/10
Garcia et al.23 veried, in the same sample ofpar-
ticipants of this study (N = 68), that 31%, 22%, 18%
and 13% of students presented an improvement of
at least ≥5%, ≥8%, ≥10% and ≥15% in reading rate
with the use of colored overlays, respectively. The
strictest improvement cutoff criterion of ≥15% in the
reading rate with overlays has clinical signicance, as
it’s a visual stress diagnostic sign15, and it represents
an increase in reading rate beyond the intraindividual
variation interval35. That is, at least one in every ten
children presents a signicant improvement in reading
rate with colored overlays. These results with a Brazilian
sample conrm the values found in different interna-
tional studies32-33,36, providing criteria validity evidence
for the Rate of Reading Test.
Veszeli and Shepherd25 evaluated the effect of
colored overlays in 106 typical children, aged four to
seven years, enrolled in the 1st and 3rd grades. The
authors veried signicant improvement in the reading
rate both with the overlay chosen as the most effective
(F(1.104) = 332, p< 0.001) and with the overlay that
offered greatest visual comfort (F(1.104) = 116, p< 0.001),
when compared to the baseline. The greatest reduc-
tions in reading time occur among younger readers,
which indicates that colored overlays may be particu-
larly efcient for the least procient readers. Veszeli
and Shepherd reported that all participants, except four
children, reduced reading time with one of the overlays;
moreover, all of them, except one, reported better visual
sharpness of the text. The use of colored overlays also
improved visual acuity for reading (close view, at 40
centimeters) in more than 40% of the children, whose
average of the Snellen equivalent passed from 20/25 to
20/20 (p< 0.001).
Hollingsworth et al.37 reinforced that deaf children
are doubly disadvantaged in reading, once they
present diminished visual and phonological abilities.
The ndings have shown that deaf participants had
greater ametropia, with reduced amplitude of accom-
modation, remote near point of convergence, and lower
rate of reading. The authors37 veried that 100% (n =
31/31) of the deaf participants had chosen at least one
colored overlay, yellow being the most frequent one
(45%, 14/31). As for the hearing control group, 67% (n
= 26/39) had chosen at least one overlay, none of the
participants opting for the yellow. In the deaf who had
chosen yellow, the reading rate increased in 18%, with
no statistical difference among the other deaf partici-
pants, nor in the hearing control group.
Reading presupposes different visual abilities, such
as binocular synchronicity and focus, comfort, sharp
and stable images, efcient eye movement, accurate
dynamic processing, and quick interpretation after a
short period of eye xation. A study38 has demonstrated
that fth grade students with reading and writing dif-
culties (RWD, n = 11) presented signicant difference
in dynamic visual acuity (though not in static acuity) and
in saccadic movement, when compared to the control
group (n = 7) (p< 0.05). The ocular motor function was
evaluated through three electrodes placed on the face,
whose results were registered by the polygraph needle
on graph paper. In the saccadic movement analysis,
all the participants in the RWD group registered irregu-
larities in eyeball movement as they followed with their
look the researcher’s nger, which was sporadically
lifted in random spots of the horizontal plane. The
unanimous difculty of the RWD group in following a
target in space may have been a determining factor
for poor school performance, hindering reading and
writing development, since such abilities require rened
eye movement control in search of letter sequencing on
paper.
In this study, students with alteration in screening
for auditory processing reported more visual stress
symptoms in the IRPS questionnaire than those with
normal DPT. Equivalent result was found in a research18
that identied that a group of dyslexic college students
(n = 16) reported more visual stress symptoms than
the control group without dyslexia (n = 26) (F(1.40) =
15.1, p< 0.05). Regardless of conditions, one of the
ways of reducing visual stress symptoms, particularly in
prolonged reading activities, has been through colored
overlays. Garcia, Momensohn-Santos, Vilhena23 veried
that students identied with severe visual discomfort
while reading (n = 11) were three times more likely
(odds ratio = 3.36) to improve the reading rate with the
overlay they had chosen, when compared to the partici-
pants with less discomfort.
Auditory and visual sensorial integration is
highlighted as of great importance to improve school
performance of children. Temporal organization,
which is the serialization of the order of facts in time,
is an important ability to learn how to read. The identi-
cation and intervention processes employed in patients
with dyslexia are different from those used in visual
processing disorders17. The diagnosis and treatment of
dyslexia involve phonological and lexical intervention
sessions3,39. It’s essential to enable education profes-
sionals to identify early the symptoms and signs of
Rev. CEFAC. 2019;21(5):e6119 | doi: 10.1590/1982-0216/20192156119
8/10 | Garcia ACO, Vilhena DA, Guimarães MR, Pinheiro ÂMV, Momensohn-Santos TM
visual stress in the reading of literate students, particu-
larly those with alteration in auditory processing, so that
they may be referred for health professionals to inves-
tigate and intervene in ophthalmic problems and visual
processing disorders15,40.
CONCLUSION
Students with alteration in auditory temporal
processing are more likely to present concomitant
impairment in visual processing, when compared to
their peers with normal auditory processing. Health
and education professionals must examine all school-
age children in order to identify, early, the alterations in
auditory and visual processing and, thus, intervene. All
instruments employed in this study, i.e., DPT, IRPS and
RRT, have shown to be important tools to investigate
the skills they measure, namely: auditory processing,
visual processing, and reading rate, respectively. In
the context of the conditions investigated in this study,
the genetic level (incidence in the family), brain level
(magnocellular decit), cognitive level (auditory and
visual temporal processing decit), and behavior level
(reading, spelling and writing difculty), should be
taken into account.
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