Kognitive Profile bei lese-rechtschreibschwachen Kindern mit und ohne Aufmerksamkeitsprobleme
Abstract
Zusammenfassung. Lese-Rechtschreibschwierigkeiten gehen sehr häufig mit Auffälligkeiten in der Aufmerksamkeit einher. Etwa jedes fünfte Kind mit Lese-Rechtschreibschwäche erfüllt auch die Kriterien einer ADHS. Für die vorliegende Studie war hierbei von Interesse, ob Kinder mit isolierten Schriftsprachschwierigkeiten die gleichen kognitiven Funktionseinschränkungen aufweisen wie Kinder mit komorbider Aufmerksamkeitsproblematik. Insgesamt 99 Drittklässler mit durchschnittlicher Intelligenz (33 Kinder mit Lese-Rechtschreibschwäche, 33 Kinder mit Lese-Rechtschreibschwäche und Aufmerksamkeitsdefizit sowie 33 unauffällige Kinder der Kontrollgruppe) wurden hinsichtlich ihrer Leistungen in der phonologischen Informationsverarbeitung, Sprache und zentral-exekutiven Arbeitsgedächtnisfunktionen miteinander verglichen. Es zeigte sich, dass die lese-rechtschreibschwachen Kinder Auffälligkeiten in den Sprachfähigkeiten, im phonologischen Arbeitsgedächtnis und in der Benennungsgeschwindigkeit aufwiesen, die Kinder mit Lese-Rechtschreibschwäche und zusätzlicher Aufmerksamkeitsproblematik dagegen in den zentral-exekutiven Funktionen. Beide Gruppen schnitten dagegen gleichermaßen schwach im Vergleich zur Kontrollgruppe in der phonologischen Bewusstheit ab. Anhand des spezifischen kognitiven Funktionsprofils können 58–64 % der Kinder korrekt zu den einzelnen Gruppen klassifiziert werden. Insgesamt zeigen sich deutliche Unterschiede in den kognitiven Funktionsmustern, aber auch Gemeinsamkeiten, die in der Diagnostik und lerntherapeutischen Intervention Berücksichtigung finden sollten.
Abstract.Background and Aims: Difficulties in reading and spelling (hereinafter referred to as dyslexia) often go hand in hand with additional problems of inattention. In fact, approximately one in five children with dyslexia also meets the diagnostic criteria of ADHD. In recent years, there is increasing interest in examining the underlying causes of dyslexia and investigating the cognitive circumstances that lead to comorbid inattention symptoms in some of these children. Although progress has been made in identifying the multi-causal nature of poor reading and spelling skills, the specificity of cognitive dysfunctions as they relate to different subgroups of dyslexic children remains to be determined. Thus, the aim of the present study was twofold: Firstly, it was of interest whether dyslexic children with versus without additional inattention problems show the same or different cognitive dysfunctions. Secondly, the study examined whether group membership can be reliably classified based on the children's cognitive profiles. Methods: Overall, 99 third-graders (33 children with Dyslexia-only, 33 children with Dyslexia + Inattention, and 33 control group (CG) children) participated in this study. The two dyslexia groups showed below-average skills in reading and/or spelling (T < 40), while the CG performed at least average in both literacy skills (T ≥ 45). All children were normally achieving in mathematics and showed at least average intelligence. Children in the Dyslexia + Inattention group exhibited additional symptoms of inattention as indicated by parent ratings. The sample completed a comprehensive test battery assessing phonological awareness, rapid automatized naming (RAN), working memory (WM), and language skills (i.e., morphology and vocabulary). Results: To address the first research question, univariate or multivariate analyses of variance (ANOVAs and MANOVAs, respectively) were conducted for each of the functional constructs. Results revealed that the cognitive profiles were different for children with Dyslexia versus Dyslexia + Inattention. Specifically, the Dyslexia-only group exhibited problems in morphology, in RAN and in the phonological loop of WM. In contrast, the Dyslexia + Inattention group showed specific impairments in the central executive. Cognitive similarities between Dyslexia-only and Dyslexia + Inattention were only found for (a) phonological awareness, in which both groups performed significantly lower than the CG, and for (b) the visual spatial sketchpad of WM, in which no deficits were observed across groups. Next, a discriminant function analysis was performed to address the second research question, namely whether group membership can be determined based on the cognitive profiles. In fact, a highly significant proportion of the sample (i.e., Dyslexia-only group: 58 %, Dyslexia + Inattention group: 64 %, and CG group: 61 %) could be classified correctly – this is more than twice the rate that would be expected based on a classification by chance (33 %). Discussion: There are clear differences but also a few similarities in the cognitive dysfunctions associated with Dyslexia-only versus Dyslexia + Inattention. In particular, children with Dyslexia-only showed typical impairments in phonological information processing with a core deficit in phonological awareness, RAN and the phonological loop. Conversely, for children with Dyslexia + Inattention, impairments in phonological processing were only evident for phonological awareness. Reduced control processes of the central executive seem to be a core characteristic associated with this double deficit group. Since phonological awareness tasks draw to some extent on central-executive processes as well as on phonological storage capacity, it is reasonable to assume that poor phonological awareness in children with Dyslexia-only can be attributed to their poor phonological loop, whereas in children with Dyslexia + Inattention it is mostly related to their poor central executive. Implications for the diagnostic process and the therapeutic interventions of affected children are discussed.
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