Explore Your Brain - Dyslexia

Reading and writing are skills fundamental to growing up in our current society. Children who struggle with such skills are not only hindered in their educational development, but also regarding self-esteem and other mental health concerns (Wilmot et al., 2023). If reading and spelling skills are not aided by remedial teaching, and children persistently score 1.5SD below the mean on reading and/or spelling tests, they can be diagnosed with developmental dyslexia (Tijms et al., 2021). 

Developmental dyslexia is a learning disorder that affects around 10% of children worldwide, depending on the exact definition (Peterson & Pennington, 2015). In the Netherlands, more than 6000 children are being diagnosed each year (NRD et al., 2014). Developmental dyslexia is characterized by problems regarding phonemic processing and awareness, and naming-speed deficits (Peterson & Pennington, 2015). Dyslexia has also been correlated with general below average processing speed and working memory (Gray et al., 2019). Besides these cognitive problems, children with dyslexia also struggle with motivational issues (Zisimopoulos & Galanaki, 2009). They have often fallen behind in school compared to their peers, irrespective of hard work, and may have received negative feedback from their teachers. Therefore, efforts have been made to counteract common internalizing problems associated with dyslexia. Administering psychoeducation is one way in these internalizing problems can be targeted.

      Psychoeducation is a well-known component of therapeutic intervention for various mental health problems. Psychoeducation is defined as providing structured information regarding the origin and the course of (mental) health problems, explanation of symptoms, and the beneficial role of treatment and support on offer. This can be done through one-on-one counseling, in a group context or through e-health modules (Tijms et al., 2021), and can make treatment more effective (Bhattacharjee et al., 2011). Firstly, increasing individual’s understanding of their mental health increases their ability to cope with their struggles. Secondly, individuals following psychoeducation have higher treatment adherence. Additionally, psychoeducation for family members can also be appropriate to increase the family’s awareness and recognition of the individual's difficulties as well as give them tools to support. In sum, psychoeducation can give tools to individuals with mental health problems to help increase well-being and effectiveness of psychotherapy and/or pharmaceutical treatment (Ferrin et al., 2014; Tursi et al., 2013). 

      A theory that has gathered increasing interest in both popular media and scientific discourse that could be a beneficial addition to psychoeducation are the implicit theories of intelligence, emotion, or personality, better known as mindset theory (Dweck, 2016). Mindset theory argues that individuals hold beliefs about malleability of their skills and other personal factors such as emotions or personality. For example, an individual with a growth mindset regarding their intelligence beliefs that they can improve through practice and putting in effort. On the other hand, those with a fixed mindset believe that intelligence is set in stone, and not something that can be improved through effort. These different views have consequences for how individuals manage difficult situations. Those with a growth mindset view these challenges as learning opportunities while those with a fixed mindset would rather steer clear from these challenges and participate in activities that they know they can perform well. 

      Research investigating implicit theories of intelligence, and related topics, has tried to shed a light on how exactly one’s mindset and skills and abilities are related. A possible mediator in this relationship could be effort beliefs, as highlighted in a study by Tempelaar and colleagues (2015). Moreover, the role of mindset in the development and treatment of mental health problems such as anxiety and depression has also been highlighted, indicating that a growth mindset is related to decreased distress and increased coping and perceived value of treatment (Burnette et al., 2020). Additionally, Schleider and Weisz (2016) found that inducing a growth mindset serves as a protective factor in stressful situations for adolescents at risk of developing internalizing disorders. 

      A pilot by the VU Amsterdam found a tentative link between mindset and dyslexia treatment success one year later (not yet published). Here, they found that children with more negative effort beliefs improve less during treatment. This was also visible on a behavioral level, where the percentage of completed homework was correlated with negative effort beliefs and fixed reading mindset. Furthermore, parents’ spelling mindset was a predictor of their child’s spelling improvement during treatment. 

      Luckily, one’s mindset is malleable. Various studies have demonstrated that interventions targeted towards increasing growth mindset in various populations, including clinical ones, can be effective (e.g., Janssen & van Atteveldt, 2022; Miu & Yeager, 2015; Rhew et al., 2018). These interventions often have overarching components; 1) basic knowledge regarding neuroplasticity, 2) growth mindset principles, 3) application of principles to domain of interest, and 4) saying-is-believing techniques. Effectiveness of such intervention in fostering growth mindset is dependent on various factors, including targeting vulnerable groups and treatment fidelity (see Burnette et al., 2023 for a meta-analytic review).

      A limited number of studies have investigated the effect of administering a growth mindset intervention to children with dyslexia or struggling readers. Research by Wanzek and colleagues (2021) found no additional effect of including the Brainology program alongside Remedial Teaching in upper elementary students on improvements in reading. They concluded that between the interventions of interest and care as usual, overall reading outcomes did not improve. However, the Brainology program was not adapted to be specific for this group of struggling readers. A recent meta-analysis and review by Burnette and colleagues (2023) has shown that when investigating specific subgroups, targeted growth mindset interventions are more effective than universal interventions. Because of this, combined with the need for dyslexia-specific growth mindset intervention expressed in previous research (Catts & Petscher, 2022), it is vital that a specific growth mindset intervention for struggling readers/children with dyslexia is developed.

Through a randomized-controlled trial, we aim to investigate the effect of a growth mindset intervention for children with dyslexia on the effectiveness of their dyslexia treatment. Our primary hypothesis is that children who have received the growth mindset intervention will improve in reading and spelling during their dyslexia treatment than children in the active control condition. Secondly, as our mechanism of change is mindset, we also hypothesize that children receiving the growth mindset intervention will show increased growth mindset compared to children in the active control condition (as well show an increase of other psychosocial measures including effort and competency beliefs).  Thirdly, we hypotheseize that children receiving the growth mindset intervention will show increased effort in a behavioural task and during their dyslexia treatment. Lastly, we hypothesize that the perception of a child's environment (parents, teachers) on the child will influence the primary outcome measures. 

The current study is a pragmatic parallel two-armed randomized placebo-controlled superiority trial comparing a mindset intervention to a time- and effort matched control intervention in children with developmental dyslexia. Participants are allocated to either the experimental or control condition in a 1:1 ratio. Participation in the study will last approximately 1 year, depending on the length of dyslexia treatment. However, the actual intervention of interest will consist of two sessions, planned over the period of 2-3 weeks, and is administered in dyslexia clinics. Study-specific data collection at T0 and T3 will be collected at the clinics. Data collection at T1 will be collected through online surveys. Diagnostic and evaluation measures (T2 and T3) already implemented in the protocol for children with dyslexia will take place at treatment locations.

Experimental intervention

The growth mindset intervention will consist of two 45 minute sessions. This time has been chosen to reflect the usual duration of dyslexia intervention sessions. The first session introduces neuroplasticity and mindset concepts are also introduced through information clips and activities as well as one-on-one discussions between the child and trainer. The second session starts with a recap activity, aimed to refresh the topics from the previous session, followed by introduction to rolemodels through videoportraits, which are followed by a semi-structured discussion. Lastly, the saying-is-believing task that is often included in mindset intervention is adapted to fit children with dyslexia into a poster creation task. 

Control intervention

The control intervention will also consist of two 45 minute sessions and mimics the experimental condition regarding type of activities and effort by the participants. The protocol of the control intervention is based on  psychoeducation materials. Its aim is to provide knowledge of dyslexia, without targeting the domains of mindset and related constructs (motivation and self-concept). Session one consists of information clips regarding the prevalence of dyslexia as well as external help that can benefit people with dyslexia, and puzzles to further explain these topics. The second session starts with a game of memory to recap the previous learned topics. The main focus is a dyslexia board game that tests dyslexia knowledge and aims to dispel dyslexia myths. It concludes with children making a poster about themselves and dyslexia. 

Intervention:
2x 45 minutes at RID location close by
Light burden, the interventions have been developed to be fun and informative for participants. 

Secondary measures:
2x 120 minutes at RID location close by for answering questionnaires and computertasks 
1x 30 minutes online questionnaire after completing intervention.
Light to medium burden. Questionnaires do not contain complex topics but the session is long for this age group. During the session protocol, extra time is reserved for respite inbetween questionnaires and tasks. One of the tasks uses EEG, the cap that is used for this may be uncomfortable.  

Primary outcome measuers are taken regardless of participating in the current study, so these do not cause additional burden.