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Purpose: to verify whether students screened with altered auditory temporal processing 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 audiological or ophthalmological evaluation were excluded. The Duration Pattern Test (screening 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 processing. Among the children with altered Duration Pattern Test, 58% improved the reading 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.
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,
Source of support: This study was
financed in part by the Coordenação de
Aperfeiçoamento de Pessoal de Nível
Superior -Brasil (CAPES) - Finance Code
Conict of interests: Nonexistent
Association between auditory temporal and
visual processing in reading skill
Ana Carla Oliveira Garcia1,2,3
Douglas de Araújo Vilhena3,4,5
Márcia Reis Guimarães3
Ângela Maria Vieira Pinheiro3,5
Teresa Maria Momensohn-Santos1
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,
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
Rev. CEFAC. 2019;21(5):e6119
Rev. CEFAC. 2019;21(5):e6119 | doi: 10.1590/1982-0216/20192156119
2/10 | Garcia ACO, Vilhena DA, Guimarães MR, Pinheiro ÂMV, Momensohn-Santos TM
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 prociency 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 dened as the perception
of change in sound within a specic 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 decit 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 difculty 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 decit 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
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.
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
Pontical Catholic University of São Paulo - PUC-SP,in
accordance with the Certicateof 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 prociency
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.
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
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 difculty 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 difculty 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
Table 1. Reading Perceptual Scale Difficulty and Discomfort Questionnaire
Difculty 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?
Rev. CEFAC. 2019;21(5):e6119 | doi: 10.1590/1982-0216/20192156119
4/10 | Garcia ACO, Vilhena DA, Guimarães MR, Pinheiro ÂMV, Momensohn-Santos TM
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
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
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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
doi: 10.1590/1982-0216/20192156119 | Rev. CEFAC. 2019;21(5):e6119
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 signicance 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 signicant.
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 classication 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 difculty
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).
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
trafc 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,
inefciency 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
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).
Rev. CEFAC. 2019;21(5):e6119 | doi: 10.1590/1982-0216/20192156119
6/10 | Garcia ACO, Vilhena DA, Guimarães MR, Pinheiro ÂMV, Momensohn-Santos TM
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
Altered Frequency 15 11 26
% 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.
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 specic time
period. It was veried 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 decit in visual processing as well.
These results are coherent with the decit in the
visual magnocellular system in dyslexics. Pammer and
Wheatley14 veried 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 specic 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
prociency becomes more and more important by
the day. It was veried 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
conguration 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
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 articial
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 difculty and discomfort
with medium spatial frequency sinusoidal grating.
doi: 10.1590/1982-0216/20192156119 | Rev. CEFAC. 2019;21(5):e6119
Auditory temporal and visual processing | 7/10
Garcia et al.23 veried, 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 signicance, 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 signicant improvement in reading
rate with colored overlays. These results with a Brazilian
sample conrm 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 veried signicant 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 efcient for the least procient 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 veried 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, efcient 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 signicant 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 difculty 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 rened
eye movement control in search of letter sequencing on
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 identied 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 veried
that students identied 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
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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.
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 decit), cognitive level (auditory and
visual temporal processing decit), and behavior level
(reading, spelling and writing difculty), should be
taken into account.
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Full-text available
As lâminas espectrais são folhas de acetato em tonalidades específicas utilizadas sobrepostas ao texto impresso com o objetivo de melhorar a leitura. As lâminas mais utilizadas na literatura internacional são fabricadas pelo Irlen Institute e pelo i.O.O. Sales. É fundamental intensificar o estresse visual previamente à seleção da melhor cromaticidade de lâmina espectral. Segundo a teoria da sensibilidade escotópica, as overlays melhoram a adaptação do leitor à luz. Na teoria do déficit magnocelular, as lâminas ajustariam a velocidade de processamento das vias magnocelulares do núcleo geniculado lateral. Por fim, a teoria da hiperexcitabilidade cortical, centrada na excitação excessiva dos neurônios corticais visuais, defende que as lâminas redistribuiriam a atividade visual para neurônios com menor excitabilidade.
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Purpose: to analyze the hearing, language, motor and social skills of children and propose a screening of child development. Methods: 129 preschool children of both sexes, aged between three and six years old, enrolled in educational institutions and 25 teachers of kindergarten from public and private institutions, with no history of hearing disorders, with type A tympanometric curves and the presence of acoustic reflexes participated. For the children, the neuropsychomotor test, Denver II, and the evaluation of sound localization and temporal ordination of three verbal and non-verbal sounds were applied. For the educators responsible for the children, the Scale of Auditory Behaviors (SAB), was used. Results: most participants with normal SAB presented hearing abilities or standard Denver II; while in the amended SAB group, most participants presented alterations in Denver II or in the auditory abilities tests. It was found, also, that part of the children with standard Denver II were pointed, by the educators, as misbehaving in SAB. Conclusion: the combination of the findings of the Denver II, hearing tests of sound localization and temporal ordination and the SAB Scale is useful in the characterization of child development and, thus, the use of these three instruments for screening in this age group is recommended.
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Purpose: Kannada, one of the Dravidian languages, is the official language of Karnataka state of India. There is a need for a test using Kannada words that can assess visual aspects of reading independently of syntactic and semantic knowledge. Methods: : A test of reading rate in Kannada was developed following the design principles of the Wilkins Rate of Reading Test (RRT). Fifteen high-frequency bisyllabic Kannada words were selected. Children were recruited from state and private schools that used Kannada or English as the medium of instruction. A total of 799 children from Grade 2 to 9 participated in the study. Reading rate was measured using the English RRT and the Kannada version twice in immediate succession during the first session. In 85 children, measurements using the Kannada RRT were repeated after an interval of 15 days. Results: Pearson product moment correlation between the two immediately successive tests was 0.95 for the Kannada RRT and 0.91 for the English RRT. The correlation for the tests separated by an interval of 15 days was 0.83. When Kannada was the medium of instruction, there was little difference between test scores for Kannada and English. When English was the medium of instruction, test scores were greater in English. Scores increased as expected with age (P < 0.0001), similarly for Kannada and English tests. Conclusion: The newly developed Kannada RRT is both reliable and valid and can be used as a tool for measuring the visual aspects of reading.
Full-text available
Objective: To investigate the effects of spectral overlays on reading performance of Brazilian elementary school children. Methods: Sixty-eight children (aged 9-12 years) enrolled in the 5th and 6th grade were included in the study. The Rate of Reading Test (RRT - Brazilian Portuguese version) was used to evaluate reading speed and the Irlen Reading Perceptual Scale was used to allocate the sample according to reading difficulty/discomfort symptoms and to define the optimal spectral overlays. Results: A total of 13% of the children presented an improvement of at least 15% in reading speed with the use of spectral overlays. Pupils with severe reading difficulties tended to have more improvement in RRT with spectral overlays. Children with severe reading discomfort obtained the highest gains in RRT, with an average of 9.6% improvement with intervention, compared to a decrease of -8.2% in the control group. Participants with severe discomfort had an odds ratio of 3.36 to improve reading speed with intervention compared to the control group. Conclusion: The use of spectral overlays can improve reading performance, particularly in those children with severe visual discomfort.
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Revisão integrativa dos processos ópticos, neurovisuais e cognitivos envolvidos na leitura de textos de línguas alfabéticas com o objetivo de auxiliar o diagnóstico e tratamento de pacientes com dificuldade de leitura. Para uma leitura mais eficiente e confortável, recomenda-se para alguns leitores treinamento de movimentos oculares sacádicos, adequação da iluminação do ambiente, uso de lâminas ou de filtros espectrais, uso da fonte Courier New com tamanho 14, e o consumo de ômega-3 e ômega-6 na alimentação diária. Quanto ao processo cognitivo, um bom leitor deve possuir adequada rota fonológica para eficiente conversão grafema–fonema, que por sua vez fortalece e consolida a arquitetura léxico-semântica. Intervenções para melhorar a performance da rota fonológica envolvem o ensino explicito do princípio alfabético, o conhecimento dos sons das letras e jogos de consciência fonológica. Traçou-se um paralelo entre a Síndrome de Irlen e a Dislexia com o intuito de auxiliar no diagnóstico diferencial e no prognóstico.
This study compared the effects of the colour and size of overlays on reading time, reading errors and on the clarity of text with young primary school children. The sample comprised a non-clinical, typical, sample from an East London primary school. One hundred and six children aged between four and seven years were asked to read 11 short passages of text (60 words) either with full page overlays or smaller reading rulers (53 in each group). This sample included younger children than has often been tested before. The 11 short passages allowed an assessment of baseline reading performance (no reading aid) and performance while reading with each of a set of ten coloured reading aids. Two different, yet beneficial, colours were determined: the most effective and the clearest/most comfortable. Both of these measures are not usually recorded. All but four children had reduced reading times with one of the reading aids and all but one reported their aid improved the perceived visual clarity of the text: the size of the reading aid did not affect reading time or visual clarity significantly. The numbers of skipped words and errors/mis-read words also decreased when reading with the most effective and most comfortable reading aid. Near visual acuity was assessed with and without each child’s most effective coloured aid. The most effective aid improved acuity in over a third of the children. Acuity has not been assessed in previous studies. As reported previously, different colours helped different children. In conclusion, coloured reading overlays reduced reading times on the reading test employed here and the size of the reading aid was not crucial to facilitate performance. The largest reductions occurred for the youngest readers, suggesting these aids may be particularly effective for early readers.
Some individuals with dyslexia demonstrate deficits in reading, visual attention, and visual processing which can be attributed to a functional failure of the magnocells in the visual system or in the dorsal visual pathway. The study examines the role of magno/dorsal function in dyslexic adults compared with normal, illiterate, and semi‐literate readers. Coherent motion and coherent form were used in Experiment 1, and the frequency doubling illusion and static‐gratings were used in Experiment 2. If a magno/dorsal deficit is demonstrated for dyslexic readers but not illiterate, semi‐literate, and normal reading adults, then the deficit cannot be attributed to reading experience. Illiterate adults performed the same as normal and semi‐literate readers in coherent motion and frequency doubling tasks, and all three groups performed better than the dyslexic readers. There was no difference between any of the groups in the coherent form or static grating tasks. Together, these studies show that illiterate and semi‐literate adults do not demonstrate a magno/dorsal deficit that is a characteristic of some sufferers of dyslexia. Therefore, magno/dorsal deficits in dyslexia are unlikely to be a consequence of failing to learn to read but rather provides evidence to suggest a causal role for reduced visual magno/dorsal processing.
Some people doubt that the concept of developmental dyslexia (DD) is useful at all because the phonological weaknesses seen in DD cannot be distinguished from those found in every person with poor reading skills, whatever their cause. Here I argue that true DD is characterized by poor temporal processing, hence impaired visual and auditory sequencing, that is caused by impaired development of transient/magnocellular (M-) systems throughout the brain. These deficits can be measured to distinguish the causes of the phonological weaknesses in DD from those causing similar deficits in other types of poor reading; Importantly this knowledge can be exploited to develop effective improvements in treatment. The evidence for impaired visual magnocellular function in many, if not all, people with dyslexia is now overwhelming; it is supported not only by psychophysical tests of M- function, but also by electrophysiological, eye movement, attentional, imaging, interventional and genetic findings. Analogously, auditory temporal processing is mediated by auditory transient, "magnocellular', processing systems, and evidence is accumulating persuasively that this system is also impaired in dyslexics. I briefly introduce the idea that 'motor magnocellular systems' may also be impaired in dyslexia, then consider genetic, immunological and nutritional factors that interact to cause the impaired magnocellular phenotype. I then discuss why the dyslexic phenotype is so common by speculating about what strengths it might confer that would maintain the responsible genes in the human genome.