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14 | Volume 52, No 2, September 2020
LDA Bulletin | Understanding links between reading diculties, self-esteem, and child mental health
Understanding links
between reading
diculties, self-esteem,
and child mental health
Mark Boyes, Suze Leitão,
Mary Claessen, Nicholas
Badcock and Mandy
Nayton are members of a
highly collaborative team
of researchers spanning
Curtin University, University
of Western Australia,
Macquarie University,
and Dyslexia-SPELD
Foundation, Perth. In this
article they provide an
update on some of their
research into child mental
health issues associated
with reading diculties,
reporting on themes
emerging from careful
qualitative research, an
analysis of clinical caseles,
and providing a heads-up
about a promising small-
group intervention program
to support the mental health
of children with reading
diculties.
Reading diculties are the most
common learning diculty in
Australia. Approximately 10%
of children have significant and
severe reading diculties, representing
between two and four children in a typical
Australian primary school classroom.
Reading diculties can severely impact
children’s lives; indeed, the notion that
children who struggle with reading
experience poor self-esteem is widely
reported, and is a generally accepted
position held by many in the community,
including teachers and educators,
counsellors, educational psychologists,
clinical service providers, as well as
familymembers.
Given the significance placed on
reading within our school system and
in so much of our day-to-day lives, the
expectation that children who struggle
with reading are also likely to experience
poor self-esteem makes intuitive sense.
Consistent with this, many adults report
that having a reading diculty had a
devastating impact on their self-esteem
as they navigated their way, painfully
and fearfully, through school.
A compelling example of this was
outlined in a recent edition of Australian
Story, featuring the highly awarded
Australian portrait artist, Vincent
Fantauzzo (Australian Broadcasting
Commission, 2019). In the program
Vincent described school as “a place I
associate with hiding, or shame, or low
self-confidence. I honestly felt like I must
be stupid”. He also described his feelings
of anxiety, and the lengths he would go
to in order to avoid detection, “I hid it
from my mum. I hid it from my brother
and sister. You become the funny kid in
class or the naughty kid. I would prefer to
be kicked out of class than stand up and
read a book out loud”. After dropping out
of school at the
age of 13, barely
able to read or
write, Vincent
managed to
hustle his way
into RMIT
University,
where he worked
tirelessly, and
has since achieved very significant
success as a portrait artist. However, it
took many years for Vincent to come to
terms with his reading diculties, and to
feel accepted for who he is.
Vincent’s school experiences are not
unique. Many children, adolescents and
adults report feeling a sense of shame
and frustration about their reading
diculties, and also report poor self-
esteem. This is by no means always the
case, however, and many children with
reading diculties remain confident,
resilient, and optimistic about their
academic and employment choices.
From the Bulletin
Learning Difficulties Australia
www.ldaustralia.org
Volume 52, No 2, September 2020 | 15
LDA Bulletin | Understanding links between reading diculties, self-esteem, and child mental health
Understanding why some children with
reading diculties struggle with self-
esteem issues, while others do not, is an
important line of inquiry.
The scientific literature confirms that
some children with reading diculties
are at elevated risk of experiencing
emotional diculties, including poor
self-esteem (particularly academic-
related self-esteem – see McArthur et
al., 2020), as well as symptoms of both
anxiety and depression (Francis et al.,
2019). However, exactly why reading
diculties are associated with poor
child mental health outcomes is unclear.
Clarifying this relationship is important
for two reasons. Firstly, it may allow the
early identification of children who are
particularly likely to struggle emotionally,
as well as those who may be resilient
to emotional problems. Secondly,
understanding this association may
highlight potential risk factors and
resilience-promoting factors that can be
targeted in mental health programs.
Our research team initially published
a ‘roadmap’ paper (Boyes et al., 2016)
that outlined a program of research
that we believed could provide a
solid foundation for systematically
investigating why children with reading
diculties may be vulnerable to
emotional problems. The aim was to
identify factors that might indicate
particular vulnerability (or resilience)
and provide a foundation for the
development of interventions promoting
mental health among children who
struggle with reading. We also called
formore collaboration between
researchers and clinical service
providers (see Box 1 for an outline of the
specific research suggestions).
In this article we provide a brief
update on the mental health research
that our research team has been
conducting in collaboration with
the Dyslexia-SPELD Foundation
(DSF) since that roadmap paper
was published. For our research, we
adopt a socio-ecological perspective
(Bronfenbrenner,1979). That is, we
view children as being at the centre
of a network of interacting influences,
including relationships with family and
friends, the contextual environment
(e.g. school and community influences),
as well as cultural and societal
factors (including policy and political
influences). Importantly, resources in
one area are argued to buer against
diculties in another.
Interviews with
children with
reading diculties,
parents, and
educators
In order to better understand the
experience of living with reading
diculties, we first conducted semi-
structured interviews with children and
their parents (Leitão et al., 2017), and a
group of educators (teachers and tutors)
who work with children with reading
diculties (Claessen et al., 2020). We
analysed the interview data thematically
(Braun and Clarke, 2006). A number of
common themes were identified in the
interviews with children, their parents,
and educators.
All participants mentioned the
impact of reading diculties on
children’s mental health. Children
reported a range of emotional
challenges, such as feelings of sadness,
disappointment and frustration,
particularly when comparing
themselves to their peers and reflecting
on their diculties in carrying out
academic tasks. Parents talked about
the challenges in supporting their
children’s mental health, particularly
their children’s lack of confidence, an
unwillingness to try new things, and
an established pattern of academic
failure. Educators reflected on their
observations of the links between
reading diculties, low self-esteem, and
poor self-confidence in the education
setting. Educators also identified the
transition to high school as being
particularly dicult for children who
struggle with reading. Within the school
setting, bullying, victimisation and
diculties with peer relationships, as
well as poor connection with school and
diculties in teacher relationships, were
highlighted as factors putting children at
risk for mental health problems.
The process of receiving a
diagnosis of a reading diculty was
identified as important by children,
parents, and educators. Receiving a
diagnosis was important for children,
as it often provided an explanation for
the challenges they experienced with
reading and learning, and enabled them
to focus on their strengths as well as
their weaknesses. Parents and educators
reflected on their perceptions of how
children responded to a diagnosis,
providing examples of reactions that were
both positive (e.g. children obtaining
a sense of resolution or relief, and an
acknowledgement that they are not
‘dumb’) and negative (e.g. children
feeling shame and that they are dierent
too other children, or that something is
wrong with them). Parents also reported
using the process of diagnosis, and the
specific nature of their child’s diculties
with reading, to help with identifying
areas of relative strength to build self-
worth and self-esteem.
Both children and educators
described the important role of parents
in providing academic and emotional
support. Consistent with this, parents
reflected on having to adopt roles such as
‘tutor’, ‘fighter’, ‘counsellor’ and ‘advocate’
for their child, roles that took them beyond
the traditional notion of being a parent.
Children indicated that having a teacher
with a knowledge and understanding of
reading diculties was important, and
parents indicated that teachers could
be both inhibitors and facilitators to the
development and education of children
with readingdiculties.
Box 1. Summary of re search suggestio ns (Boyes et al., 2016)
Summary of research suggestions
• Carry out in-depth interviews with children, parents, educators, and clinicians
to identify potential risk and resilience-promoting factors identified by
stakeholders
• Collaborate with clinical ser vice providers to use detailed clinical records to
identify factors associated with mental health among children with reading
diculties
• Evaluate the eectiveness of mental health promotion programs for children
who struggle with reading
• Include brief measures of mental health when implementing reading
interventions, to test if improvements in reading are associated with
improvements in mental health
Understanding why some
children with reading
diculties struggle with self-
esteem issues, while others
donot, is an important line
of inquiry.
From the Bulletin
Learning Difficulties Australia
www.ldaustralia.org
16 | Volume 52, No 2, September 2020
Box 2. Summary of r isk and resilience-pr omoting factors identifi ed in the child, parent, and educ ator
intervie ws (Leitão et al. 2017; Claessen et al. 2020).
Children attending Clever Kids.
Summary of risk and resilience-promoting factors
Risk Factors Resilience-promoting Factors
• Low self-esteem
• Academic failure
• Shame, stigma and feeling ‘dierent’
• Experiences of being bullied
• Peer relationship problems
• Teacher training (early literacy)
• Unsupportive teachers and school
sta
• Transition to high school
• Financial cost and lack of resources
• Lack of government recognition (and
associated funding/resources)
• Early diagnosis
• Identifying any child strengths
• Positive general self-concept or
perception
• Strong relationship with parents
• Strong relationships with friends/
peers
• Strong and supportive teacher
relationships
• Supportive school environment
• Connection with school
Parents also reflected on a range of
broader themes, including a need for
recognition of the issues surrounding
access to (and the cost of) the extra
support they sought for their child
(e.g. assessment, tutoring, and speech
pathology services), the importance of
teacher training in the areas of reading
development and early literacy, and
the lack of government resources and
financial support for children with
reading diculties.
Taken together, the findings from
the interviews with children, parents,
and educators identified a variety of
risk and resilience-promoting factors
associated with child mental health (see
Box 2). Importantly, these factors span a
range of levels. Perhaps unsurprisingly,
children tended to focus on individual,
family, and school-related experiences,
whereas parents and educators were
better able to contextualise reading
diculties within broader societal and
cultural contexts.
Analysis of clinical
caseles
While the interviews with children,
parents, and educators provided
us with rich and detailed data, the
small number of people interviewed
means that we need to be cautious in
generalising these findings too broadly.
To complement these interviews, we
conducted an analysis of data extracted
from Dyslexia SPELD Foundation (DSF)
casefiles (Boyes et al. 2020a).
DSF conducts over 1500
assessments each year, and the
majority of parents give consent for
this data to be used in research and
evaluation. A casefile is created for
each child and, along with results from
assessments of literacy and reading-
related achievement, casefiles also
include parent-reported information
on behavioural, social, and emotional
development. This provided a unique
opportunity to draw on these detailed
clinical records to identify factors
associated with mental health among
children with reading diculties. We
collated the 1235 casefiles of school-
aged children who had received a
dyslexia diagnosis from DSF in 2014
and 2015 and then randomly selected
a subset of 450 casefiles for data
extraction. Consistent with previous
studies, we noted significant rates of
low self-esteem, as well as behavioural
and emotional problems. Low self-
esteem and behavioural diculties were
reported for around 25% of children,
while rates of emotional diculties were
reported for around 10% of the children.
This pattern of findings likely reflects
the fact that behavioural problems are
observable and tend to create diculties
in the classroom and at home, in
contrast with emotional diculties
which are often hidden. Importantly,
it should be highlighted that not all
children experienced low self-esteem,
behavioural, or emotional issues;
indeed the majority of children had not
experienced any of these. This reminds
us of the importance of understanding,
and identifying, which children with
reading diculties may struggle with
self-esteem, as well as behavioural and
emotional problems.
In terms of potential risk and
resilience-promoting factors, in our
analysis of the DSF casefiles we
identified four factors that appeared
to be important in identifying children
who had experienced emotional and
behavioural problems: (1) low self-
esteem, (2) experiencing peer problems
and being bullied, (3) diculties with
regulating emotion, and (4) social skills
diculties. Of note, these findings are
broadly consistent with the factors
identified as being important by the
children, parents, and educators we had
interviewed previously, and we believe
that they might be good intervention
targets for programs aiming to promote
mental health among children with
reading diculties.
Mental health
programs for
struggling readers:
the ‘Clever Kids’
program
DSF has identified increased
demand for psychosocial support,
with growing expectation that it be
LDA Bulletin | Understanding links between reading diculties, self-esteem, and child mental health
From the Bulletin
Learning Difficulties Australia
www.ldaustralia.org
Volume 52, No 2, September 2020 | 17
oered in addition to targeted reading
intervention. However, there are few
mental health programs developed
specifically to be accessible for children
with reading diculties. One exception
is Success and Dyslexia, a coping
program, which has a particular focus on
children with reading and other learning
diculties (Firth and Frydenberg, 2011).
However, this program is implemented
school wide, with the learning diculties
coping program nested within a broader
whole-school program. Whole-school
programs can be dicult to implement,
as they need a concerted eort by
school administration and sta. DSF
have therefore adapted the Success
and Dyslexia program and developed
Clever Kids, a nine-week mental
health program that is delivered by
DSF psychologists in small groups
(approximately 10 children) outside of
school hours. The small group structure
also gives participants an opportunity to
meet other children similarly struggling
with reading.
Clever Kids focuses on the
development of coping and emotion
regulation skills, resilience and self-
esteem (factors identified as being
linked with mental health outcomes
in our previous studies), as well as
problem-solving skills, perseverance,
and help-seeking behaviour. In addition,
it includes a combination of explicit
instruction, modelling, role-playing,
and ongoing revision of concepts being
taught (see Appendix for an outline of
the program structure). The activities
have been designed to be accessible for
children with reading diculties, and
parents are kept informed of content
so they can support their children in
practicing skills taught in the program.
We have recently completed a
small randomised-controlled trial
of Clever Kids (Boyes et al., 2020b,
manuscript under review). Our findings
showed attending Clever Kids improved
children’s coping skills and there were
also promising improvements in self-
esteem and reductions in emotional
problems. The program also appears to
be acceptable to children with dyslexia
and their families.
What have we
learned, and where
to next?
Our interviews with children,
parents, educators, as well as our
exploration of DSF case files, highlight
that although rates of emotional
diculties are indeed higher among
struggling readers, many children with
reading diculties are very resilient.
Our research has identified a number
of risk and resilience-promoting factors
(summarised in Box 2) that can help us
better understand why some children
with reading diculties may struggle
emotionally, while others may not.
Together, our findings point to the
need to support children with reading
diculties at multiple levels – taking into
consideration the unique experiences of
each child, as well as the important role
of family, peers, teachers and schools,
government, and broader society in
understanding the emotional impacts of
reading diculties.
Regarding mental health promotion,
our preliminary trial of the Clever Kids
program has identified promising
improvements in self-esteem and some
reduction in emotional problems among
struggling readers. In addition, the
children enjoyed the program, particularly
the social (and normalising) aspects of
meeting other children who also struggle
with reading. However, this was only
a small pilot study; we have recently
received funding to conduct a larger trial
of Clever Kids, which we hope will confirm
the program is having a positive eect.
The final recommendation in our
‘roadmap’ paper on reading diculties
and mental health (Boyes et al.,
2016) was to include brief measures
of emotional health before and after
implementing reading interventions,
to test if any improvements in reading
correlate with improvements in child
self-esteem and mental health. We
have not yet investigated this, but
we believe it remains an important
question, and is an area in which clinical
service providers and researchers could
collaborate very fruitfully.
Conclusions
We hope our research identifies aspects
of classroom practice that teachers can
reflect on to better support children
with reading diculties. Children
and parents both highlighted the
positive influence of educators who
understood (and believed in) reading
diculties, as well as the protective
nature of high-quality relationships with
teachers and schools on emotional
wellbeing. This understanding and
acceptance is an impor tant foundation
for supporting children with reading
diculties in educational settings.
To develop this foundation, there is a
need for schools and teachers to be
provided with high quality evidence-
informed information and support (DSF
Literacy and Clinical Services, 2019).
We believe that together parents,
teachers, schools, clinical service
providers, and researchers play a
crucial role in supporting children with
reading diculties, and that it is through
advocating together, to amplify our
voices, that we can best support the
children with whom we work.
References
Australian Broadcast Corporation
(2019). ABC News In-depth, Australian
Story: Vincent Fantauzzo: Drawing a life
in paintings.
Boyes, M.E., Leitão, S., Claessen, M.,
Badcock, N.A. & Nayton, M. (2016). Why
are reading diculties associated with
mental health problems? Dyslexia, 22,
263-266.
Boyes, M.E., Leitão, S., Claessen, M.,
Badcock, N.A. & Nayton, M. (2020a).
Correlates of externalising and
internalising problems in children with
dyslexia: An analysis of data from clinical
casefiles. Australian Psychologist, 55,
62-72.
Boyes, M.E., Leitão, S., Dzidic, P.,
Claessen, M., Badcock, N. & Nayton,
M. (2020b). Piloting ‘Clever Kids’: A
randomised-controlled trial assessing
feasibility, ecacy, and acceptability
of a socioemotional wellbeing program
for children with dyslexia. PsyArXiv
(manuscript submitted).
Bronfenbrenner, U. (1979). The ecology
of human development: Experiments
… parents reected on
having to adopt roles such as
‘tutor’, ‘ghter’, ‘counsellor’
and ‘advocate’ for their
child, roles that took them
beyond the traditional
notion of being a parent.
LDA Bulletin | Understanding links between reading diculties, self-esteem, and child mental health
Children and parents both
highlighted the positive
inuence of educators who
understood (and believed
in) reading diculties, as
well as the protective nature
of high quality relationships
with teachers and schools on
emotional wellbeing.
From the Bulletin
Learning Difficulties Australia
www.ldaustralia.org
18 | Volume 52, No 2, September 2020
bynature and design. Harvard
UniversityPress.
Braun, V. & Clarke, V. (2006). Using
thematic analysis in psychology.
Qualitative Research in Psychology, 3,
77-101.
Claessen, M., Dzidiz, P., Boyes, M.,
Badcock, N. Nayton, M. & Leitão, S.
(2020). Educators’ perceptions of the
impact of reading diculties for young
people. Australian Journal of Learning
Diculties, 25, 51-64.
DSF Literacy and Clinical Services
(2019). Understanding Learning
Diculties – A Practical Guide (Revised
Edition). DSF Literacy and Clinical
Services.
Firth, N. & Frydenberg, E. (2011).
Success and dyslexia: Sessions for
coping in the upper primary years.
Australian Council of Educational
Research.
Francis, D.A., Caruna, N., Hudson, J.L. &
McArthur, G.M. (2019). The association
between poor reading and internalising
problems: A systematic review and
meta-analysis. Clinical Psychology
Review, 67, 45-60.
Leitão, S., Dzidic, P., Claessen, M.,
Gordon, J., Howard, K., Nayton, M.
& Boyes, M. (2017). Exploring the
impact of living with dyslexia: The
perspectives of children and their
parents. International Journal of Speech-
Language Pathology, 19, 322-344.
McArthur, G.M., Filardi, N., Francis,
D.A., Boyes, M.E. & Badcock, N.S.
(2020). Self-concept in poor readers:
A systematic review and meta-
analysis. PeerJ, 8, p. e8772. https://doi.
org/10.7717/peerj.8772
The authors are based at the following
institutions:
Mark Boyes*: School of Psychology,
Curtin University, Perth, Western
Australia
Suze Leitão and Mary Claessen:
School of Occupational Therapy, Social
Work and Speech Pathology, Curtin
University, Perth, Western Australia
Nicolas Badcock: School of
Psychological Science, University of
Western Australia and Department
of Cognitive Science, Macquarie
University, Sydney
Mandy Nayton: The Dyslexia-SPELD
Foundation, Perth, Western Australia
Acknowledgements
The research repor ted in this article
was funded by Healthway, through
a research grant (24342), and an
Australian Rotary Health – Mental
Health Research Grant. Mark Boyes is
supported by the National Health and
Medical Research Council, Australia
(Investigator Grant 1173043).
Conicts of Interest
Mandy Nayton is the Chief Executive
Ocer of the Dyslexia-SPELD
Foundation. Suze Leitão is a board
member of the Dyslexia-SPELD
Foundation. Mark Boyes and Mary
Claessen are members of the Dyslexia-
SPELD Foundation.
Twitter handles:
Mark Boyes (@me_boyo),
Suze Leitão (@suze_freogirl),
Mary Claessen (@SpeechMary),
Nicholas Badcock (@NicBadcock),
Mandy Nayton (@mandynayton &
@DyslexiaSPELD).
* Corresponding author:
Dr Mark Boyes
Senior Research Fellow
NHMRC Emerging Leadership Fellow
School of Psychology
Faculty of Health Sciences, Curtin
University
GPO Box U1987
Perth, Western Australia, 6845
Phone: +61 8 9266 7025
Email: mark.boyes@curtin.edu.au
Web: www.markboyes.com
Twitter: @me_boyo
LDA Bulletin | Understanding links between reading diculties, self-esteem, and child mental health
From the Bulletin
Learning Difficulties Australia
www.ldaustralia.org
Volume 52, No 2, September 2020 | 19
LDA Bulletin | Understanding links between reading diculties, self-esteem, and child mental health
Box 3. Outline of th e nine-week Clever Kids program (Boyes et al., 2020b)
Appendix
Outline of the Clever Kids program
Week Topic Content of the session
1 Introduction to the
program and identifying
personal strengths
Establishes that ever yone in the group
has reading diculties, and that the
group provides an opportunity to talk to
other children likely to have experienced
similar diculties. Emphasises that
although individuals with dyslexia may face
challenges, they have many strengths as
well. Students reflect on personal strengths
and accomplishments
2 What do reading
diculties mean to me?
Discusses what reading diculties are and
provides students with opportunities to
share how this impacts them. Highlights that
students can be successful despite their
learning diculties.
3 How do you cope? Introduces concepts of coping and emotion
regulation. Explores dierent ways of coping
and managing emotions and highlights that
dierent strategies are useful in dierent
situations. Discuss how to make helpful
choices about coping with diculties and
managing emotions.
4 What are your goals? Introduces SMART (specific, measurable,
achievable, relevant, and time limited)
goals and highlights how helpful coping and
emotion regulation strategies are important
in pursuing goals (particularly in planning
and responding to problems as they arise).
5Problem solving and
managing negative
emotions
Re-emphasises information from sessions
3 and 4 and applies it specifically to stress
(and bodily manifestations of stress).
Outlines fight, flight, freeze responses, and
teaches specific stress regulation strategies
(e.g. breathing exercises).
6 Choosing powerful
thoughts
Introduces links between thoughts, feelings,
and behaviour. Discusses how to identify
and challenge unhelpful thoughts and self-
beliefs. Provides an opportunity to apply
positive thinking strategies to situations
students identify as dicult.
7 Why be assertive? Discusses dierences between being
assertive, aggressive, and passive (and
potential outcomes of these). Highlights how
to respond to diculties by assertively trying
to improve the situation, rather than acting
aggressively towards others or withdrawing
from the situation.
8Assertiveness skills Students have the oppor tunity to practice
assertive verbal and non-verbal behaviour,
including making assertive requests and
using assertive body language.
9 Revision and integration Reviews the concepts, skills, and strategies
that have been covered in the program.
Provides an opportunity for students to
reflect on the progress they have made over
the course of the program. Celebrates the
successful completion of the program.
From the Bulletin
Learning Difficulties Australia
www.ldaustralia.org