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Remedial Reading: A Necessary Component of Interdisciplinary Schizophrenia Treatment Plans
Psych Progress
Remedial Reading: A Necessary Component of Interdisciplinary Schizophrenia Treatment Plans
Stephen I. Deutsch, MD, PhD
Ann Robinson Endowed Chair in Psychiatry, Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School; Attending Psychiatrist, Sentara Norfolk General Hospital, Norfolk, Va.
First published in Psychiatry Weekly, Volume 9, Issue 12, December 15, 2014
A recent study found that deficits in the early processing of auditory and visual sensory information could underlie an impaired reading ability of patients with schizophrenia. The schizophrenia patients (N=45), whose IQ scores were ≥85, had intact prior reading ability. Impaired reading ability was associated with reduced socioeconomic achievement and, within the patient sample, the formal oral reading quotient of the Gray Oral Reading Test correlated positively with the problem-solving factor subscale of the Independent Living Scales, which is a measure of “functional cognition.”
The investigators explored the relationship between sensory dysfunction in schizophrenia and acquired impairment of reading ability. The ability to scan text accurately is dependent on early visual processing, such as visual contrast sensitivity, and the ability to “sound out” words depend on early auditory (phonological) processing, such as auditory tone matching ability. Like the patients, age-matched controls (N=24) had IQ scores >85 and were native English speakers.
Relative to controls, the reading ability of patients was significantly impaired and, in general, the effect sizes for measures of their reading deficits were larger than the effect sizes of the general cognitive deficits and deficits of sensory processing. Within the patient group, the effect sizes for the measures of impairments of reading fluency were greater than the effect sizes for measures of reading comprehension. The grade-equivalent reading scores of the patients were significantly lower than the years of completed education. Patients were significantly impaired on measures of early sensory processing and, across groups, an association was found between sensory processing and reading ability. Based on passage reading, 73% of the schizophrenia patients met criteria for acquired dyslexia, whereas only 2.4% would meet criteria based on single word reading ability.
Several important conclusions emerged from this research: that bottom-up deficits in early sensory processing traits (visual), and disturbance that manifests around the time of illness onset (auditory), contribute to the acquired dyslexia of patients with schizophrenia; whereas schizophrenia patients may show little or no impairment of their ability to read and pronounce single words aloud, their ability to read passages fluently may be impaired; the detection and diagnosis of acquired dyslexia is rarely made; and targeting the deficit in passage reading may be a remedial cause of the vocational impairment observed in these patients.
Greater attention must be given to the assessment of reading disability in patients with schizophrenia because it contributes significantly to downward drift and functional and vocational impairment. Also, interventions designed to mitigate the effects of sensory processing deficits on reading disability are a critical and neglected component of individualized, multi-modal interdisciplinary treatment plans for schizophrenia patients, especially early in the course of illness.
Disclosure: Dr. Deutsch has received grant support from the Commonwealth Health Research Board (State of Virginia).
References:
Revheim N, Corcoran CM, Dias E, Hellmann E., et al. Reading deficits in schizophrenia and individuals at high clinical risk: relationship to sensory function, course of illness, and psychosocial outcome. Am J Psychiatry. 2014;171:949-959.