[MUSIC] What can eye longitudinal study on dyslexia tell us? We finished the last lesson on comorbidities by suggesting how the different dyslexia profiles of Bob, John, Mary, and Mann, in essence shaped their adult lives. They all have children by now. Some of them will inherit dyslexia. Hopefully longitudinal studies can give us evidence based understanding and training. Our focus so far has been on levels of assessment and finding a good definition. However, our young friends are going through stay stages of development by age, maturation, schooling, which all influence the outlets and nature of their dyslexia. So, we have to follow them through the pre literacy, emergent literacy, and literacy stages. In this lesson, I will use our Bergen Longitudinal Dyslexia Study, also called Speak up, as an example. We base their project on the four level model to analyze the different aspects of dyslexia, and use the 2002 version of the BDA definition, which is very similar to the 2007 definition, which we have presented here. On this basis, our aim was to identify and follow up children at risk of dyslexia and controls focusing on preliterate detection, neurocognitive development, brain imaging, heredity, gender. Here I will give you a brief summary. On the Map you see Norway, and participants in the project were from four municipalities of Western Norway. Spread across many kindergartens and later schools. To find children at risk, a questionnaire was to be answered by parents and preschool teachers was constructed. You will recognize the domains distributed on the four levels. A risk index was calculated and the highest score meant high risk. From this risk index 13 boys and 13 girls were defined to be at risk, and 36 children matched for age and gender made the control group. The project plan was divided into fall and spring activities. Fall activities were screening and testing. Please note the spring activities in the pre emergent literacy stages, the children trend using special database programs. Functional fMRI was used three times in spring when the children were six, eight, and 12 years old. A special reading test was constructed for the purpose. And then there have been meetings, conferences, thesis, publications, all along the project period. Before we go on, something has to be said about the training. 20 minutes sessions individually every day for two to three months, every spring at the ages of five, six, and seven, evidence based computer programs were used as far as possible, with two programs that had been used clinically with good recommendations. From the logs of the trainers, the children seem to enjoy the individual training immensely. The training was based on two principle. BU, bottom up, and TD, top down. The bottom up training started with training perception of rapidly switching sounds and pictures. Then training intervals and rhythm with database sounds from music instrument. Finally, and in line with school curriculum, working with graphemes and phonemes started. The top down training started with whole language applied to storytelling for the two first years, and with creating stories and word writing in grade two. Dyslexia was defined as the blind testing of a sum of reading and writing scores when the children were 11 years old in the literacy stage. 13 of the 109 original children were defined with dyslexia. 12 came from the risk group and one from the control group, a result which validated our risk index positively. Then the data could be analyzed in retrospect and by group. Before we go on with other data, we have to keep in mind that the sample is relatively small. That gender and heredity distribution may seem surprising should be understood in this context. Here we found that there literacy differences between the groups increased by age. However, all within the dyslexia group had attained functional reading and writing level, which we thought was great, but the processing speed was slow. They made more mistakes also, however within a critical range. Again, it's important to point to the evidence based training of the children in the pre emergent literacy stages. They were trained by two different pedagogical principles that most teachers will recognize. Bottom up from sound and visual patterns to whole language reading and writing. Top down from whole language to sounds and visual patterns. We concluded that early evidence based training combining these two principles had a positive effect on both the control group and the dyslexia group. While the group differences increased by age at the symptomatic level, they decreased by age at the cognitive level. Importantly, the predictors of age 11 literacy skills changed from lower level in the pre emergent literacy stage, to the higher level functions at the literacy level. Similar changes are reported in other studies, and they may be due to the intensive and early literacy training. Three sessions of fMRI scanning was executed, one when the children was six, then when they were eight, and finally when they were 11 years old. It may be comforting for you to hear that there are very strong regulations for children taking part in all research, especially this kind of research. The children and their parents took pride in the project. And here you can see the mother and her six year old son together with our very competent radiographist. Here are examples of the tasks the children were given when they were in the scanner. They were reading task from different stages and they were to push a button as a response. One of our main findings was that cortical thickness differences were only observed before learning to read, in lower level areas responsible for auditory and visual processing, and core executive functions in dyslexic children. But, this difference leveled out during the emergent and literacy stages. Going to the more functional network, another finding was that the control group showed stable or decreasing connectivity measures. The dyslexia group, on the other hand, show more unstable connectivity measures from they were six till they were eight. But then it's sort of leveled out or normalized from eight to 11 years old. So was that both as the cognitive and the brain scanning sort of leveled out the smaller and smaller differences between the control groups and the dyslexia group. At age 11, when dyslexia was identified by blind scoring, we saw significant correlations between the literacy scores and the risk index scores, which was calculated when the children were five. Further, when the participants from the whole original group were 15 years old, they were among other things asked to report their school marks in their first language Norwegian, their second language, English, both referring to written exams and to mathematics. These grades correlated significantly with a risk index, again calculated when the children are five years old. That is a higher risk score correlated with low marks, which indicate that risk factors of dyslexia can be found in pre school. All Ms preliterate detection of risk factors following neurocognitive development see what brain imaging at three age points assess the hereditor gender. These were our first Ms when we started. What we found was at the symptomatic level, the risk index had a predictive value. Early database training combined both bottom up and top down had effect at the cognitive level. Differences to controls decreased by literacy stages. At the biological level, brain scanning differences to controls decreased by literacy stage. Familiar dyslexia was seen in 62%. The gender distribution was a bit surprising. More girls than boys were identified with dyslexia. Environmental level, all in the dyslexia group reported that The Light School, which is very fortunate, they had had a good time and maybe that's because of their reading and writing skills. All point to the importance of an early identification and intervention. But, there are some limitations of course to this study as there are two other studies. There are small numbers, there are no external control group. But this study also has some strengths that we should emphasize, it is population based, it has a clear definition, it is analyzed by the four levels, it has no teacher effects. Instead the children are distributed to many schools and preschools. Development and brain data is very exceptional, to have those longitudinal. And the cognitive benchmarks are also longitudinal, which is not so common in studies of dyslexia. Of course, further research is needed. First of all, we would wish to have a replication study. And we need more focus on the risk index, our five questionnaire. We need more on individual testing of identified at risk preschool children on cognitive benchmarks, brain mapping, gender, heredity on all the things we have been doing. But other longitudinal studies refer to some of the same findings as we have. Longitudinal studies are rather rare since they need so much people, so much effort, so much staying power. So, I have put some other longitudinal studies in the reference list. And as I said, there are some common findings, but what you should note especially is how the participation criteria are, if they are clinical, if they are hereditary basis, or genetics, or as our study population based. So finally, a thank to all participants and there have been several hundred both children, parents, teachers, clinicians, researchers, students. It has been a whole group of people who have done a very good job over ten years. It's really amazing how they could do this. Also, a thanks to my participants, med participants, Professor Kenneth Hugdahl, and Professor Karsten Specht, who have been responsible for the fMRI part. And also our newspaper at University of Bergen, put us on the first page saying that we find dyslexia ahead of reading age. Thank you.
