الفهرس 
Acknowledgement
Cortical areas of the brain involved in reading and writingOnly 14 pages are availabe for public view
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Abstract
Education is a fundamental human right and it has a great impacte on growth and progress. School failure can lead to serious consequences if untreated. The failing student losses self-confidence subsequently becomes discouraged and involved in self-harming or antisocial behavior. Unforuntally, Egypt ranked just before the last position among the 124 countries in the world in terms of the quality of primary schools, and the same place in the quality of education and training systems, according to the report made clear human capital index issued by the World Economic Forum, (2015). The present study was based on the proposal that students with SLD have deficits in one or more of the basic cognitive skills that contribute mostly in the learning process. Thus the study aimed at identification of points of weakness in cognitive abilities of those students, using a specifically constructed Arabic computerized visual and auditory cognitive skill battery, as a prelimenarly step for rehabilitation and cognitive training of those students. Then construction of visual and auditory computerized cognitive skill battery for cognitive rehabilitation of SLD students, each student according to his domains of cognitive deficiency.
Subjects:
The study was conducted among governmental primary school students in Assiut city, where students were selected out of 4th grad students.
The study was carried out through the following stages: Stage I: Identification of students with SLD ( according to discrepancy model).
All students of the 4th grade of the chosen 6 schools (n= 858 students) were interviewed except those who were absent during their school visits (n= 142 students). Or those who did not complete the test battery (achievement tests, IQ, visual and/ or auditory cognitive skill tests) (n= 56 students). The rest of the sample (660 students) have completed the test battery.
All students were subject to: I.1- Evaluation of their intelligence quotient by using standardized Arabic version (Melika and Ismeel,1999) of Wechsler Intelligence Scale for Children- Revised (WISC-R) (Wechsler, 1974 )
I.2-Evaluation of their achievement level: In reading by using ART (Arabic Reading Test) ( Abou El-Ella et al., 2004) , in mathematic by using Math test (Farghaly, 2001) and in writing by using Writing test
[It is the sum of the script part (visuo – motor integration test which was specifically designed for this study) plus spelling part of ART].
After these two steps ( I.Q and Achievements):
We selected 2 groups from students with I.Q ≥ 90:
- group I: those with poor achievement (˂ mean – SD) and I.Q ≥ 90 were considered students with SLD ( our target in this study).
- group III: those with good achievement (˃ mean + SD) and I.Q ≥ 90 were considered as a control group.
Then the students with SLD were subjected to:
I.3-Complete neurological examination: with special emphasis on soft neurological signs by using Cambridge Neurological Inventory ( Chen et al., 1995).
I.4-Psychological assessments:
I.4.a For depression using Arabic translation of Children depression inventory (CDI) of Kovacs, 1992 ( El-Theeb, 2001),
I.4.b For anxiety, using Arabic translation of State-Trait Anxiety Inventory for Children (STAIC) ( El-Behairy and Ibraheem,1982) and
I.4.c For ADHD, using Arabic translation of Conner ’s test (El-Behairy and Aglan, 1997) toghther with application of DSM-V criteria.
I.5- Audiological assessment by:
Basic tests (audiometery and tympanometery ) to exclude peripheral hearing loss.
Central Tests:
1-Verbal Tests: Speech in Babble test (Arabic Speech Intelligibility in Noise test) and Dichotic Digits Test (Soliman et al., 1995).
2-Non-Verbal Tests:Duration Pattern Sequence Test (Musiek et al., 1990 I.6-Ophthalmological examination:Visual acuity simply examined by counting fingers at 6 meters to exclude gross visual deficits.
Results of the 1st stage
According to WISC-R, it was found that, 48.9% of the total sample had I.Q ≥ 90 (n= 323/660). After application of achievement tests it was found that, Prevalence of SLD among 4th grade public school students of Asyut city was 16.06% (n=106/660). Dyscalculia was the most common type of SLD (11.4%) followed by dysgraphia (5.8%) and then dyslexia (5.3%).
Dyscalculia was more prevalent among girls than boys while dyslexia and dysgraphia were more prevalent among boys than girls and total SLD was more prevalent among grils (16.2%) than boys (15.9%).
Co-morbid conditions for a sample of students with SLD (n=19).
- Only one boy had above average depressive symptoms by CDI.
- 8 students had above average anxiety state and only 2 students had above average anxiety trait by using STAI.
- 6 students had significant degree of ADHD by using Conner̕ s rating scale but no one fulfilled the diagnostic criteria of DSM-V.
- 7 students had positive soft neurological signs ( positive Fist-edge-palm sign of the left hand) by using CNI.
- No one of the students had peripheral hearing loss.
- 6 students had central auditory deficits and this represent 6/19 = 31.60% of the sample (diagnosis depends on 2 abnormal psych-physical central auditory tests).
Stage II: Construction of an Arabic computerized diagnostic battery based on reading of previuos diagnostic tests and the suggested auditory and visual cognitive skills that contribute mostly in the process of learning and that could be deficient among students with SLD.
The constructed battery was designed to test the following cognitive skills:
A-Visual cognitive skills in:
1-Visual closure
2- Visual discrimination
3- Visual memory &Visual sequential memory
4- Visual comprehension
5- Visual-spatial ability
6- Whole - part relationship
7- Visuo-motor integration test.
B-Auditory cognitive skills in:
1- Phonological awareness
2- Auditory discrimination
3- Auditory Memory& sequencing memory
4- Auditory comprehension
5- Auditory sustained vigilance(attention)
Stage III: Standardization of the constructed diagnostic battery.
Reliability:
Depending on internal consistency reliability which inturn depends on measurement of values of Cronbach’s alpha correlation coefficient (Trochim, 2001), values of inter-item correlation matrix, corrected item-total correlation coefficient( Pallant, 2007), and by factorial reliability depending on values of communalities which were considered an indicator of reliability ( Farag, 1980).
Validity:
We relied on measuring the following:
1-Judgement validity (face validity):
After revising the opinion of the 7 referees some modification of the items of the battery were done.
2- Construct validity:
Depending on measurement of factor analysis to determine construct validity.
3-Contrasted group validity: We depended on T-test for comparison of scores of SLD ( group I according to standardized achievement tests or lowest score according to final school tests in Arabic and Math.) and non-SLD students ( group III according to standardized achievement tests or highest score according to final school tests in Arabic and Math.)
4-Diagnostic validity: we used sensitivity, specificity, Positive predictive value, negative predictive value and Receiver Operating characteristic ( ROC ) curve tests.
Results of the 3rd stage
A) Reliability:
- Inter-Item correlation matrix of both visual and auditory cognitive skill subitems are significantly positively correlated to their main subtests and to their corresponding total visual and auditory cognitive score.
- Cronbach̓s Alpha values of auditory, visual and whole cognitive skill battery tests indicate a high reliability (Cronbach̓s Alpha coefficient value of most items >0.70).
- All values of the corrected item-total correlation of both visual and auditory cognitive skill tests are > 0.2. This means that all items belong to the same construct and all tests of both visual and auditory cognitive skills are reliable.
- All values of the communalities of the visual and auditory cognitive skill battery are high and reliable (>0.40) except auditory attention (.263).
B) Validity:
Construct validity:
Factor analysis
- 8 subitems of the battery, show high loading on the 1st factor and those represent visual cognitive skills.
- Another 7 subitems have high loading on the 2nd factor, and those represent auditory cognitive skills.
- Only one subitem ( visuo-motor integration ) shows high loading on the 3rd factor
- All loadings of visual and auditory cognitive skill items are high and valid ( ˃ 0.3) according to Guilford criteria (1946).
- This means that 1st factor is a pure factor and its items belong to the same construct. Similarily, 2nd factor is a pure factor and its items belong to the same construct and differe from 1st factor. Finally 3rd factor is a pure factor and differ from the 1st and 2nd factors.
Contrasted group validity:
- Students of group III (good readers, those with good mathematical abilities and good writing abilities) have significantly higher mean scores than students of group I (dyslexics , dyscalculics and dysgraphics respectively) in most visual and auditory cognitive skill tests except in some subitems where group III have insignificantly higher scores than group I.
- Students of group III (good achievers in Arabic school marks) have significantly higher mean scores than students of group I ( poor achievers in Arabic school marks, probably with dyslexia and/ or dysgraphia) in the total visual and auditory cognitive skill tests and all thier sub items.
- Students of group III (good achievers in math. school marks) have significantly higher mean scores than students of group I (poor achievers in math. school marks, probably with dyscalculia) in the total visual and auditory cognitive skill tests and all thier sub items.
Diagnostic validity:
- In dyscalculia, the sensitivity of the total battery was (58.6%) and the specificity was (75.9%). This that means the total battery was good and specific test in diagnosis of cases of dyscalculia but had lower sensitivity in screening of such cases. It is a good diagnostic test.
- In dyslexia, the sensitivity of the total battery was 52.8% while the specificity was 90%. This that means the total battery was excellent and specific test for diagnosis of cases of dyslexia but had lower sensitivity in screening of such cases. It is an excellent diagnostic test. The AUC for the whole battery in cases of dyslexia was (0.871) which means that is a good diagnostic test.
- In dysgraphia, the sensitivity of the total battery was 100% while the specificity was 77.9%. This that means that the total battery was perfect and sensitive for screening and picking up cases of dysgraphia and also had good specificity in diagnosis of such cases. It is a perfect screening and diagnostic test.
- The largest AUC in case of dyscalculia was the area that represent total auditory cognitive skill test (0.753) (good diagnostic test) and the area of the total battery was (0.695) which means that is a fair diagnostic test
- The largest AUC in case of dyslexia was the area that represent total auditory cognitive skills (0.835) (good diagnostic test) followed by the area that represent the visual cognitive skills(0.824) (good diagnostic test). The AUC for the whole battery in cases of dyslexia was (0.871) which means that is a good diagnostic test.
- The largest AUC in case of dysgraphia was the area that represent visuo-motor test was (1.0) (perfect diagnostic test) followed by the area that represent the visual cognitive skill test (0.983) (excellent diagnostic test), the area of auditory cognitive skill test (0.712)(fair diagnostic test) and the area of the total battery was (0.926) which means that it is a very good diagnostic test for cases of dysgraphia.
Stage IV: Construction of Arabic computerized battery for training of students with SLD according to their cognitive deficits detected in the 3rd stage. This program included both visual and auditory skill training in a computerized manner as follow:
A-Visual cognitive skill training program:
This included training in the 7 main visual skills and their subitems by using the constructed computerized program.
It included the following:
(visual closure,visuo-spatial relation, visual memory, visual Sequencing memory, whole - part relationship,visual discrimination and visual comprehension).
B-Auditory cognitive skill training program:
Which included: (Phonological awareness, auditory discrimination, auditory memory,auditory sequential memory, auditory comprehension and auditory attention).
C-Writing training program
Training in writing disabled students (students with dysgraphia ) was carried out manually by the help of a special training computerized program that learned the student how to write the letters, words, numbers and phrases. Then further script activities were conducted by the student at home for repeated training under supervision of his/her parents and was revised by the skilled trainer.
Stage V: Implementation of the constructed training program for a sample of students with SLD (n= 19 students), each according to his/her diagnosed cognitive skill deficit.
Training procedure
19 students diagnosed as SLD received training sessions on both auditory and visual cognitive skills.
- Each student attended three sessions per week
- Every session will last from 90-120 minutes.
- Students were asked to attend, together with one or both of their parents. The training program was implemented in the neuro – epidemiology research center in the Faculty of Medicine, Assiut University. Training was conducted at the end-year holiday in the morning.
- The program was implemented under supervision of 3 neurologists and 2 educational staff members. Follow up sheet was constructed for each student to evaluate the time and errors for each item of the training program.
- Remediation sessions will continue for 18 weeks (2 weeks for writing training and 8 weeks for visual and 8 weeks for auditory skills). Thus each student will attend 54 training sessions [6 sessions for writing program, 24 sessions for visual and 24 sessions for auditory cognitive skills].
Stage VI: Post- training re-evaluation of academic achievement and cognitive skill performance at the end of implementation of the constructed training program. At the end of training sessions, re-assessment of achievement of those students using ART, math and writing tests as well as the constructed diagnostic computerized visual and auditory skill battery to evaluate the impact of the neuro-cognitive training program on academic performance of students with SLD as well as on their cognitive skill performance.
Results of the 6th stage:
Re-evaluation of cognitive profile of students with SLD:
- The most frequently encountered deficits in cognitive skills among our sample of students with SLD (19 students) are phonological awareness and auditory sequential memory (78.9% for each) followed by total auditory memory, total auditory attention and total auditory (68.4% for each) then total auditory comprehension, auditory discrimination and total visual (63.1% for each).
- After training most items of cognitive skills had improved. There were statistically significant increase in the mean scores of total visual cognitive skills and in all its 7 main subitems of the study group (group I) after implementation of the training program except in visual comprehension. However, in some individual subtests the increase in the post-training mean score, didn’t reach statistically significant level.
- There were statistically significant increase in the mean scores of the total auditory cognitive skills and in all its subitems of the study group (group I) after implementation of the training program except in (rhyming and phoneme blending) where the increase did not reach a statistically significant .level