Predicting Late-Emerging RD: Neurobiological and Cognitive Factors

描述（由申请人提供）：阅读障碍（RD）是一种严重的终身疾病，对社会有重大的公共卫生后果。美国国立卫生研究院过去的研究提供了大量关于早期（K-3）阅读发展和干预的信息。然而，很少有研究调查的性质，儿童发展RD在中间年级（4 - 5年级）。对这种RD的估计（Leach等人创造的“晚发性RD”或LERD）表明，LERD的患病率并非微不足道，在小学后期确定患有RD的人群中，其患病率为20%至46%。因此，LERD很可能是导致4年级和8年级阅读失败发生率较高的一个重要因素（约为30%; NAEP，2007），并表明迫切需要了解更多关于LERD的根本原因的公共卫生需求。在此背景下，当前项目的目标是确定与LERD相关的认知和神经生物学特征，并确定LERD与早期阅读失败（RD-Early，或RD-E）的相似性或不同性。为了实现这一目标，拟议的研究由两个目标组成。具体目标1是确定患有LERD的五年级儿童样本中同时存在的行为和神经元弱点。该计划是利用一个独特的情况，其中一个随机选择的纵向队列，是以前的研究（最初不是设计研究LERD）的一部分，可供我们使用。我们假设LERD儿童与RD-E儿童相比，表现出不同的认知和神经生物学特征，在口头语言和执行功能的各个方面都有特别的弱点。该研究的具体目标2是使用五年级学生中已确定的弱点领域来指导认知和神经生物学措施的预测电池的开发，以表征早期LERD风险的行为和神经生物学特征。我们推测，口头语言缺陷和执行功能缺陷将突出LERD。我们计划对第二批儿童进行为期数年的随访，获取行为和神经生物学数据，以更好地了解LERD的发展。最终，这一系列的研究旨在通过确定学校应该包括哪些措施作为LERD风险的早期标识符来改变目前的做法，以及为LERD风险的早期干预计划。此外，通过使用神经生物学和认知测量，我们不仅将专门了解LERD，而且还将有助于理解大脑成熟，特别是连接，随着时间的推移。因此，这项研究不仅对理解LERD有价值，而且对理解儿童发展有更广泛的帮助，因为它将提供有关大脑成熟及其与儿童认知发展关系的信息。 公共卫生相关性：晚期出现的阅读障碍（LERD）具有显著的公共卫生后果; LERD的患病率并非微不足道，在小学后期被确定为RD的人群中，患病率为20%至46%。该项目将使用神经生物学和认知测量来发现早期LERD风险的神经生物学特征，并建立LERD的发展特征。最终，这项研究有可能改变目前的做法，确定学校应该包括哪些措施作为早期识别那些有LERD风险的人，以及为那些有LERD风险的人制定早期干预计划。

DESCRIPTION (provided by applicant): Reading disability (RD) is a serious, life-long condition that has significant public health consequences for society. Past NIH research has provided a lot of information about reading development and intervention in the early grades (K-3). However, few studies have investigated the nature of children who develop RD in the intermediate grades (4th-5th grade). Estimates of this RD (coined by Leach et al. as "Late-Emerging RD", or LERD) suggest that the prevalence of LERD is non-trivial, ranging from 20% to 46% of those identified with RD in late elementary school. Thus, it is likely that LERD is a significant contributing factor to the substantial prevalence of reading failure in 4th and 8th grades (which is about 30%; NAEP, 2007) and suggests an urgent public health need for understanding more about the underlying causes of LERD. Within this context, the goal of the current project is to determine the cognitive and neurobiological profile associated with LERD, and establish how LERD is similar or different than early reading failure (RD-Early, or RD-E). To accomplish this goal, the proposed study is composed of two aims. Specific Aim 1 is to identify concurrent behavioral and neuronal weaknesses in a sample of 5th grade children with LERD. The plan is to capitalize on a unique situation in which a randomly selected longitudinal cohort that is part of a previous study (not originally designed to study LERD) is available to us. We hypothesize that children with LERD will show a distinct cognitive and neurobiological profile compared to RD-E, with particular weaknesses in various aspects of oral language and executive function. Specific Aim 2 of the study is to use the areas of identified weaknesses in the fifth graders to guide the development of a predictive battery of cognitive and neurobiological measures to characterize the behavioral and neurobiological profiles of those at risk for LERD in earlier grades. We hypothesize that oral language deficits and executive function deficits will feature prominently in LERD. We plan to follow this second cohort of children for several years, acquiring behavioral and neurobiological data to better understand the development of LERD. Ultimately, this line of research seeks to change current practice by determining what measures schools should include as early identifiers for those at risk for LERD, as well as develop early intervention programs for those at risk for LERD. In addition, by use of both neurobiological and cognitive measures, we will learn not only specifically about LERD, but also will contribute generally to understanding brain maturation, particularly connectivity, over time. Thus, this research will not only be valuable to understanding LERD, but also will be more generally helpful to understanding child development, as it will serve to provide information about brain maturation and its relationship to cognition in developing children. PUBLIC HEALTH RELEVANCE: Late emerging reading disability (LERD) has significant public health consequences; the prevalence of LERD is non-trivial, ranging from 20% to 46% of those identified with RD in late elementary school. This project will use both neurobiological and cognitive measures to discover the neurobiological profiles of those at risk for LERD in earlier grades and establish the developmental profile of LERD. Ultimately, this research has the potential to change current practice by determining what measures schools should include as early identifiers for those at risk for LERD, as well as develop early intervention programs for those at risk for LERD.