Working memory (WM) is an essential cognitive process for the acquisition of learning in reading, writing and arithmetic, allowing for the proper processing of environmental stimuli; people with dyslexia (DLX) have alterations in this neurocognitive process, mainly in handling verbal information. The objective of this study is to analyse the link between MT, verbal memory, visual/verbal memory, consciousness level, mind control and semantic memory in a sample of 130 schoolchildren diagnosed with DLX. In order to identify the link between the aforementioned variables, a structural equation model (SEM) was constructed in RCran 4.0.4 software, using the results obtained in the psychometric tests applied; WISC-IV, Visual/Verbal Memory, Verbal Memory and Wechsler Memory Curve. This paper concludes that people with DLX have deficiencies in several memory domains, the neuropsychological stimulation of this process is fundamental to guarantee the scholastic progress of the population with this neurodevelopmental disorder.
Article Details
How to Cite
Quintero-López, C., Gil-Vera, V.-D. ., Bolívar-Villamil, . L., Mazo-Benítez, K.-C. ., Serna-Jaramillo, M., Ciro-Graciano, L.-M. ., & Restrepo-Arias, K.-C. . (2022). Working memory in school children with dyslexia: A relational analysis. Ocnos. Journal of reading research, 21(2). https://doi.org/10.18239/ocnos_2022.21.2.2886
Quintero-López, Gil-Vera, Bolívar-Villamil, Mazo-Benítez, Serna-Jaramillo, Ciro-Graciano,
and Restrepo-Arias: Working memory in school children with dyslexia. A relational analysis
Introduction
According to the Diagnostic and Statistical Manual of Mental Disorders [DSM-V] (2013)
neurodevelopmental disorders (2013), they are early-onset clinical disturbances, which
break out before school age and affect the educational, social and family sphere;
they have a negative impact on academic learning, executive functions, social skills
and intelligence. (; ). Specific learning disorder falls within this group of clinical entities, characterised
by impairment in the acquisition of academic skills in reading, writing or arithmetic
(). It has been referred to as dyscalculia (problems in learning mathematical skills),
dysgraphia (impaired writing expression) and DLX (difficulties in learning to read).
(; ). There is a higher prevalence of DLX in the school population, reported to be between
5% and 15% (; ). People diagnosed therewith show inaccuracy in reading words, poor lightness, poor
understanding of texts, and poor reading comprehension, problems in pronunciation
and visual processing (). Profiling studies indicate that DLX is associated with neurocognitive impairments.
(; ; ). WM is essential to acquire reading, writing and mathematical learning (; ; ). There is low performance on neuropsychological tests assessing verbal WM in people
with DLX, research findings have reported significant alterations in this neurocognitive
process (; ). WM allows for the proper manipulation of the medium's information through encoding,
processing and immediate recall (; ; ). Baddeley’s approach has been a significant clinical and scientific benchmark for
theorising WM (central executive), made up of by the articulatory loop and the visuospatial
agenda (; ). The visuospatial agenda is committed to the performance and sustainment of visual/spatial
information; the articulatory loop is the verbal memory responsible for receiving
information from the environment and the linguistic cognitive system, and maintaining
the phonological codes for a short period of time (; ; ). Research has concluded that WM deficits in patients diagnosed with DLX are found
in verbal memory, associated with problems in level of awareness, mind control, slow
speed in naming verbal and visual symbols affecting the processing and storage of
phonological material (; ; ). Semantic memory is involved in spontaneously acquired knowledge about the environment,
it directly influences the functionality of WM, in the pedagogical context it allows
the manipulation of linguistic codes for the acquisition of literacy skills. (; ).
There is a wide range of research indicating that people with DLX have impairments
in memory components, mainly in WM (, ; ), but there is little scientific evidence analysing the relationship between these
components; these findings motivate the following research question: What is the link
between WM, verbal memory, visual/verbal memory, consciousness level, mind control
and semantic memory in schoolchildren with DLX? Deficits in this neurocognitive component
should be addressed clinically, fostering this population’s educational progress ().
Based on the above, the aim of this research was to analyse the link between WM, verbal
memory, visual/verbal memory, consciousness level, mind control and semantic memory
in schoolchildren with DLX. The following relational research hypotheses were formulated:
H1. In people with DLX, the lower the WM functionality, the greater the impairment
of verbal memory, H2. In people with DLX, the lower the WM functionality, the greater
the deficits in visual/verbal memory, H3. The greater the alterations in consciousness
level, the lower the functionality of mind control and H4. The lower mind control,
the greater the deficiencies in semantic memory. It was concluded that in DLX, WM
is affected and is directly related to the clinical manifestations of this neurodevelopmental
disorder.
Method
Participants
From a population of 156 patients with neurodevelopmental disorders, patients (N=130) diagnosed with DLX were included in the sample. The 26 who were excluded had
sensory deficits or intellectual disabilities. The sample under analyses was made
up of primary/secondary school children, ranging in age from 7 to 15 years. 82 males
(Mage=9.30, SDage=2.18, right-handed=75, left-handed= 7, ambidextrous= 0) and 48 females (Mage=9.27, SDage=2.23, right-handed= 42, left-handed= 5, ambidextrous= 1). The medical records of each
patient were analysed to identify the presence/absence of neurological risk, family
history of DLX or deficiencies in successive developmental milestones (17 patients
with neurological risk and delays in successive developmental milestones, 26 patients
with neurological risk and no delays in successive developmental milestones, 23 patients
with neurological risk and no neurological risk, 64 patients with no neurological
risk and no delays in successive developmental milestones).
Design
The study had a quantitative approach, the level was relational, non-experimental,
cross-sectional design ().
Instruments
Wechsler Intelligence Scale -Wechsler- (WISC-IV) (). It makes a comprehensive assessment of cognitive/intellectual functioning and is
administered among individuals aged between 6 and 16. It is made up of 10 primary
tests and 5 supplementary tests. For this research, the tests measuring the WM index;
letter/number succession-digit retention, which assesses recording and data retention
skills, were applied. Letter/number succession, estimates storage and combination
capabilities of various types of information; the test taker is read a set of letters
and numbers, then asked to output the letters in the order of the alphabet and the
numbers in an ascending arrangement. The maximum score of this cognitive activity
is 30; it includes 10 items each made up of 3 items, and the test is terminated when
the test taker has 3 scores of zero on the same item. Digit retention, examines sequential
skills, organisation, alertness and cognitive flexibility of WM. It includes two activities;
digits in direct arrangement (the test taker repeats the numbers in the same arrangement
as presented by the tester), digits in reverse arrangement (the test taker repeats
the numbers in the opposite arrangement as presented by the tester). It is made up
of 8 items, each with two items; a score of zero on both items of an item is a fail.
Each test’s score involves the conversion of direct scores into scalar scores. The
reliability of the scale was tested through test-retest, it has content validity (; ).
Wechsler Memory Scale- (). Administered individually, this test allows for the assessment of the fundamental
aspects of memory (information, orientation, mind control, logical memory and associated
pairs) in different age groups. The information and orientation test assess the level
of awareness through very simple questions about personal elements, basic general
culture, location in space and time. Mind Control, made up of three activities, aimed
at assessing automated and controlled processing (counting backwards from twenty to
one, repeating the alphabet and counting from 3 to 3 starting from 4 up to 40). Logical
memory, made up of two stories that are read to the person being tested for immediate
recall. Associated pairs, consists on introducing the patient to a pair of words to
be memorised, and then telling him to remember the second word while the first word
is presented. The version validated by for Colombian children and adolescents was applied to the sample. The test has appropriate
construct and content validity.
Verbal Memory Curve (). The test taker is given 10 words sequentially and must recall the words he remembers
immediately after each presentation. Up to 10 verbalisations and evocations of the
words are allowed, aiming a certain maximum volume. The score obtained from the initial
volume indicates the number of items that the person tested remembers after the first
exposure. The maximum volume refers to the number of items that can be evoked after
up to 10 training sessions. The test has adequate validity and reliability.
The Visual/Verbal Memory Scale (). A template with 10 drawings is presented for the person tested to say the name
of each drawing, then the visual template is removed so that they can immediately
recall the ones they remember, the test allows for up to 10 trials. Initial volume,
assesses the number of words evoked after the first trial; peak volume, assesses the
maximum number of words evoked after up to 10 trials. The test has adequate validity
and reliability.
Procedure
This study was approved by the Research Ethics Committee of Universidad Católica Luis
Amigó under file number 62542. At the Neuropser Neuropsychology Specialised Care Centre
(Medellín-Colombia), the sample of primary and secondary school children between the
ages of 7 and 15 years with a diagnosis of DLX was assessed. The supervisors of the
population assessed agreed to sign the appropriate informed consent form for the minors
to participate in the research project. The application, scoring and interpretation
of the test protocol provided was carried out by a team of professionals specialised
in neuropsychology; the assessment of each participant was carried out individually,
with an average of two hours. This research was financed by the Universidad Católica
Luis Amigó under code 0502029969 of the Cost Centre.
Data analysis
The sample descriptives and SEM were performed within the RCran 4.0.4 environment
for statistical computing. Covariance was analysed between the latent variables; WM
verbal memory, visual/verbal memory, consciousness level, mind control and semantic
memory of the tests provided. SEMs allow the validation of hypothesised constructs
between latent variables from observable variables, they are a class of multivariate
structures (). These models determine the dependence or independence relationship by integrating
linear equations, combining factor analysis with linear regression to calculate the
data fit. Goodness-of-fit tests were performed; Chi-Square, the Comparative Fit Index
(CFI), the Tucker Lewis Index and the p-value of indicators.
Results
Table 1 presents the summary of descriptive statistics for the characterisation of the patients
under analysis. It shows that there are more men than women (82>48), age was similar
for both sexes. Participants in the sample were aged between 7 and 15 years. Most
patients were right-handed, the number of left-handed patients was the same in both
sexes (7 patients), only one female patient was ambidextrous. The patients’ level
of education ranged from first grade of primary school to ninth grade of high school.
32% of patients were at neurological risk and 68% were not. 30% of the patients under
analysis lagged behind in the successive evolution of the developmental areas. Neurological
risk represents adverse factors in the pregnancy/delivery process and family history
of DLX; deficiencies in developmental areas present divergences between chronological
age and expected developmental milestones (; ; ).
Gender
No.
Age
RN
RAD
Laterality
D
Z
AD
Man
82
9.30
2.18
Yes= 27 No=55
Yes= 20 No=62
75
7
0
Woman
48
9.27
2.23
Yes=15 No=33
Yes=19 No=29
42
5
1
Total
130
Yes=42 No=88
Yes=39 No= 91
117
12
1
Table 1Descriptive statistics
The LAVAAN library was used to build the SEM, the model converged after 95 iterations.
The number of degrees of freedom of the SEM was 30, the Chi-square statistic was greater
than 503, defining an adequate model. The Comparative Fit Index CFI=0.856 > 0.5, as
well as the Tucker Lewis Index TLI=0.737 > 0.5, indicate the relevance of the SEM.
The p-value of the indicators suggests significance, the model developed is valid. All the values of the covariances analysed were positive, accepting the hypotheses
put forward. Table 2 presents the results of the SEM.
Assumption
Covariance
Criterion
P(>|z|)
H1. In people with DLX, the lower the WM functionality,the greater the impairment
of verbal memory
0.72
Accepts
0,000
H2. In people with DLX, the lower the WM functionality,the greater the deficits in
visual/verbal memory
0.51
Accepts
0,000
H3. The greater the alterations in consciousness level,the lower the functionality
of mind control.
0.55
Accepts
0,000
H4. The lower mind control, the greater thedeficiencies in semantic memory
0.55
Accepts
0,000
Table 2Relational hypotheses
Figure 1 presents the diagram of the developed SEM. The numerical value above the two-way arrows
indicates the value of the covariance. Variables between rectangles indicate observed
variables, variables between ovals indicate latent variables.
Figure 1Structural Equation Model
Note. Verbal Memory (Mmr Vr), Visual and Verbal Memory (Mmr Vs), Consciousness Level (N)
and Mind Control (C_M), Semantic Memory (M_S)
Discussion
According to epidemiological data, DLX is more prevalent in men (). The sample analysed in this research was mainly made up of men. Some predisposing
factors for DLX have been identified that are not determinant; neurological risk,
hereditary background and delay in developmental areas (). In the sample analysed, 62% had predisposing factors, which shows that not all
people diagnosed with DLX have neurological risk or deficiencies in developmental
areas.
From the results of the SEM in the DLX there is a deficit in WM, which directly affects
verbal memory. This finding is consistent with the results of some research that suggests
that DLX generates abnormalities in verbal memory, affecting the functioning of the
phonological component of WM, manifesting in perceptual and linguistic difficulties
(; ; ). It was evidenced that people with DLX present alterations in the processing of
visual/verbal information, implying impairments in visual memory, a slowing down in
the processing of data captured from the environment; attention operates in an articulated
manner with WM for the automated processing of stimuli. From the scientific background
review, little research validates this claim, and it was found that DLX generates
deficits in visual processing, negatively impacting the performance of tasks that
assess WM (; ; ).
Schoolchildren with DLX show failures in tasks that measure mind control, they have
a lower ability to focus attention, they do not have adequate competences to regulate
the information they receive from the environment due to inhibitory control failures
(). This research finding is consistent with hypothesis H3 stated in this research.
Attention and WM are fundamental for mind control, cognitive processes that facilitate
the learning of pedagogical competences. (; ). The impairment in mental control linked to DLX has an impact on semantic memory
functionality (). argue that deficiencies in WM and its link with verbal and visual memory and mental
control lead to a decrease in semantic storage, with reduced orthographic processing,
especially in the early stages of school, adversely impacting academic learning. Studies
show that DLX is due to an impaired pattern of recall (episodic/semantic), has been
attributed mainly to impaired phonological processing, suggests a conceptual link
between reading difficulties and phonological and orthographic integration deficits.
Early intervention for language deficits reduces the risk of WM limitations, a key
component of good reading and writing performance. (; ; ).
It is concluded that WM is impaired in patients diagnosed with DLX mainly at the level
of verbal memory (articulatory loop) and mental control. In this clinical condition
there are deficits in explicit memory affecting semantic memory and visual and verbal
memory. The SEM developed allowed us to identify that in people with DLX the deficiencies
in WM are related to verbal, visual and controlled processing alterations, generating
and maintaining some of the symptoms associated with this clinical condition (slow
learning, difficulties in morpheme formation, problems in the storage and evocation
of phonemes). Studies assessing visual and verbal memory in people with DLX are suggested,
the scientific evidence is not conclusive. The results of this research are limited
to Spanish-speaking people with DLX. It is important that psychology and neuropsychology
continue to explore the link between WM and DLX in order to foster specialised intervention
processes for this population.
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