A study on the psychological functioning of children with specific learning difficulties and typically developing children

Abstract

Introduction

Dyslexia is a widespread Specific Learning Difficulty, and children with dyslexia often face significant psychological difficulties due to their challenges with reading, spelling, and writing.

Objective

This study examines the psychological functioning of children with dyslexia and compares it with typically developing children.

Method

This cross-sectional study used the Child Behavior Checklist (CBCL) to evaluate behavioral issues and the State Trait Anxiety Inventory (STAI) to assess anxiety levels. Primary school teachers, who had known the children for at least a year, provided the reports. Data were analyzed using an independent sample t-test.

Results

Forty children with dyslexia (n = 40) and fifty typically developing children (n = 50) were assessed, in which both groups are predominantly boys (70%, 54%) aged 7–12 years (Mean age:9.3 ± 1.5). The results indicate a significantly greater degree of behavioural problems t(88) = 8.39,p < 0.001 among children with dyslexia compared to typically developing children. They also had higher level of anxiety t(88) = 6.81,p < 0.001 compared to typically developing children.

Conclusion

The findings highlight a strong connection between emotional and behavioral issues in children with dyslexia. Generally, these children are more prone to depression, anxiety, and disruptive behaviors compared to their peers. The study underscores the importance of a multidisciplinary approach that integrates emotional needs assessment and management into the interventions for children with dyslexia.

Introduction

Specific learning difficulties (SLD) are neurodevelopmental conditions that typically present in early childhood and may persist throughout an individual’s life [1]. SLD involve problems in academic performance, particularly in reading, writing, and solving mathematical problems. The condition affects various educational domains in education, with each manifesting distinct academic challenges. The first type of SLD is dyslexia, which is characterized by difficulties in recognizing words accurately and struggling with phonological awareness, a crucial component of the reading process [2]. The second type is dysgraphia, which involves problems in writing and is characterised by difficulty in expressing ideas on paper [3]. The third type is dyscalculia, which is a difficulty in solving mathematical problems [4].

Approximately 1 in 10 people could be affected by learning difficulties, putting more than 700 million children and adults worldwide at risk of life-long illiteracy and social exclusion [5]. The global prevalence of SLD is estimated to be between 2% to 10%, with 80% of diagnosed individuals having dyslexia [6]. In Malaysia, the estimation is mainly referring to the number of enrolments for the Special Education Integration Program which is implemented in regular schools under the Ministry of Education, Malaysia. Data from the Ministry of Education stated that there were 50,662 students who enrolled in the Special Class for Learning difficulties which constituted approximately one percent of the total enrolment of students in all public educational institutions [7]. From the total number of students enrolled in the Special Class for Learning difficulties, nearly two-third are in primary schools and the rest are in secondary schools. In addition, there are also 599 preschool children enrolled in the Special Preschool Class for Learning difficulties which are provided by several schools in Malaysia.

According to the American Psychiatric Association [8], a diagnosis of dyslexia requires a minimum of six months of persistent reading difficulties despite targeted interventions addressing areas of weakness. Despite a substantial increase in public awareness and understanding of dyslexia [9], the negative stigma remains firmly entrenched within the society, with similar attitudes observed across various cultures. Around two decades ago, a study by Hoehn found that many in Western cultures believed that ‘dyslexia' was a term created to serve the interests of special education teachers [10]. More recent research supports this, suggesting that parents use the diagnosis of dyslexia to secure additional support for their children [11]. An educational psychologist at Durham University argued that the term 'dyslexia' is often used as a label to explain children's academic difficulties [12]. These arguments contradict with the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), which state that intellectual disability (ID) and SLD cannot coexist and therefore are distinct conditions [13]. In fact, individuals with dyslexia often have average to superior intelligence quotients (IQs) [10].

To date, the exact aetiology of dyslexia remains unknown despite a huge number of studies has attempted to provide the explanation [14]. Genetics have been found to play a major role in the development of dyslexia, suggesting it is an inherited condition [15]. Other research indicates that children with dyslexia have less gray and white matter in the left parietotemporal area compared to children without dyslexia [16]. Having less gray matter in this region of the brain has been linked to deficits in phonological awareness which is a skill that enables a person to differentiate individual sounds of spoken language. A reduction in white matter volume, on the other hand has been associated with decreased reading skills [17]. One explanation for this is that having less white matter in the area causes disruption in the communication between the lobes of the brain which play a significant role in language and speech production. In addition, unlike the brain architectures of right-handed non-dyslexia individuals, reversed asymmetry (right larger than left) or symmetry hemispheres have been observed in those with dyslexia [18].

Numerous studies have shown that the differences in literacy abilities between children with dyslexia and their peers significantly impact psychological functioning [19, 20]. Psychological functioning includes behaviors, emotions and social skills that affect overall mental health [21]. Children with dyslexia often experience frustration [22], anger [23], and higher levels of anxiety [24] compared to their peers without literacy difficulties. They may also experience social rejection [25] from their peers which subsequently increase their feelings of loneliness [26] and lower their self-esteem [27]. Some studies suggested that these psychological challenges can be severe enough to contribute to suicidal tendencies [19]. One possible reason could be due to the dissonance of having an average to superior IQ but not being able to perform as well as their peers [10].

It is important to note that dyslexia is a lifelong condition without a known cure, and children with dyslexia must cope with these challenges as they grow up [28]. This highlights the need of equipping children with dyslexia with adaptive coping strategies to manage their emotional and behavioral difficulties they may experience due to the differences in their learning styles and capabilities. However, most interventions for dyslexia focus primarily on academics remediation, such as training in letter sounds, phoneme awareness, and linking letters with phonemes through reading and writing [29, 30]. Programs like the Orton-Gillingham Approach [31] and Discrete Trial Training, [32] emphasise improving academic skills, and little attention is given in equipping the children with socio-behavioural and emotional awareness, understanding, and its management [30].

In Malaysia, the identification and enrolment of students with dyslexia involve a multi-faceted approach, starting with screening programs at both primary and secondary levels, which often include assessments of reading abilities and cognitive processes. Once identified, students may receive a formal diagnosis through collaboration with psychiatrists, psychologists, and specialised assessments. The process of enrolment generally includes the development of Individualized Education Plans (IEPs) tailored to the specific needs of each student [33]. These IEPs guide targeted interventions and support, such as specialised teaching methods and assistive technologies.

Due to the limited availability of intervention focusing on strengthening their psychological functioning, children with dyslexia often continue to face psychological difficulties even after their academic difficulties have been addressed [19]. Support is necessary not only for these children to receive quality education comparable to their peers [34], but also to ensure they have a positive educational experience. Therefore, the current study aims to examine the psychological functioning of children with dyslexia, by comparing their scores in psychological problems in general, and anxiety in particular, with their typically developing peers. We hypothesized that children with dyslexia would score significantly higher than their peers.

Method and materials

Study design, sampling recruitment and ethical approval

This is a retrospective cross-sectional study conducted from January 2020 through February 2021. The sampling frame was established from the list of names of students registered with Special Education Integration Program (i.e. Program Pendidikan Khas Integrasi, PPKI) and enrolled in Special Class for Learning Difficulties, in particular, Dyslexia class in Kelantan, Malaysia who was our target population group from Kelantan State Education Department. Purposive sampling was employed to select participants who specifically met the criteria for inclusion in the study. We sampled the children between the age of 7 to 12 years old, to represent children attending primary school during the data collection period. G*Power analysis was used to determine the sample size needed to evaluate the difference in means between two independent groups with a t-test. With the pre-setting made as one-tailed test, moderate effect size of 0.5, power level of 0.6, and an equal allocation ratio of 1, the suggested sample size was 60 participants. To account for potential dropouts, the sample size was increased by 50%, resulting in a final sample of 90 participants. The analysis uses Cohen’s 2013 formula, where the Z-score for the alpha level (α = 0.05) is approximately 1.96, and the Z-score for the desired power (80%) is about 0.84. An estimated standard deviation of 1 is assumed, guiding the sample size planning based on these parameters. We identified six schools that provide special education classes in Kelantan. From this list, we chose one Kelantan district to focus on, which was a decision made due to the feasibility factor as it was during the Movement Control Order period. Ethical approval was obtained from the Human Research Ethic Committee Universiti Sains Malaysia (USM/JEPeM/20080428), all participants signed informed consent forms, and the study was conducted in accordance with the Declaration of Helsinki.

To be eligible, the students’ school placement must be in PPKI, and they must have been previously diagnosed with dyslexia by medical officers – as one of the requirements before they could enrol in Dyslexia Class. They must also be confirmed by the class teacher as not having any comorbid conditions such as ADHD, autism, and global developmental delay. Children with co-morbid conditions were excluded as symptoms from other disorders might be confounding variables. Typically developing children were obtained from mainstream class as they are assumed to not have any learning disabilities. However, teachers were asked to inform the researchers if any of the students from the mainstream class have any physical or mental illness to be excluded in the studies as this can also be confounding variables. The teachers, who were the respondents in this study, must have known and/or taught the children they assess for at least one year, to be eligible to fill up the questionnaires.

Participants

A total of ninety (n = 90) children participated in this study, of which 40 were diagnosed as having dyslexia and 50 were typically developing children who attended mainstream schooling. Of the total sample, 70% are boys and 30% are girls. The children were between 7 to 12 years old and the mean age for both groups was 9.3, (SD = 1.55). Almost all children were Malay and Muslim in both groups (dyslexia group n = 38; 95.0% and typically developing group n = 49;98.0%). More than half of the children in the dyslexia group registered their learning difficulties with the local social welfare department (65.0%) based on the teachers' reports. The learning activity status of the children in the dyslexia group: 17.5% were active, 62.5% were less active, and 20% were inactive. While for the typically developing children, 50% were active in learning, 42% were less active and 8% were not active. In terms of the performance in basic academic skills including arithmetic, writing and reading skills, almost half of the children in dyslexia group were reported to perform poorly in all skills. An overview of the demographic characteristics of the children are presented in Table 1.

Table 1 Demographic characteristics of the dyslexia and typically developing groups

Materials

Two questionnaires were completed namely the Child Behavior Checklist (CBCL) and the State-Trait Anxiety Inventory for Children (STAI-C). The CBCL is a widely used instrument that assesses social competence and behavioral problems of children between 6–18 years of age [35]. The problem scale consists of 113 items that can be divided into three global scales which are internalizing, externalizing, and total behavioral problems. The items can also be divided into eight subscales which are ‘anxious/depressed’, ‘withdrawn/depressed’, ‘somatic complaints’, ‘social problems, ‘thought problems’, ‘attention problems’, ‘rule-breaking behavior’, and ‘aggressive behavior’ that were assessed in the current study. The instrument is completed by the teachers based on their observation of their children’s behaviour within the past six months. Each question was scored on a 3-point Likert scale (0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true) [35]. The raw score obtained were then converted to standardized T-scores with higher scores indicating higher behavioral difficulties. Permission to use the Bahasa Malaysia translation of the CBCL/6–18 was obtained from Professor Thomas Achenbach. Internal consistency for the Child Behavior Checklist scales used was good to excellent ranging from 0.72 to 0.96 [36]. In Malaysia, the CBCL has been used in different types of research involving children [37]. The STAI-C was developed by Spielberger to measure susceptibility to anxiety (trait) and current level of tension and apprehension (state). The STAI-C State assess how children feel "right now", at this moment" (e.g., "My student feel upset") and STAI-C Trait targets how children "generally feel"(e.g., " My student lack self-confidence"). Each item is rated on a 4-point scale, ranging from 1 (almost never), 2 (sometimes), 3 (often), to 4 (almost always). The items are summed to produce a total score with higher score indicating a higher degree of anxiety [38]. License for use of STAI-C in this study was obtained from Mind Garde Inc. Previous generalization reliability of STAI-C in exploring anxiety demonstrated high internal consistency (Cronbach’s alpha, α > 0.89) [39].

A section of the questionnaire consists of questions regarding the demographic background of the participants such as age of children, their sex, types of disorders they are diagnosed with, duration of illness and their learning activity status during the data collection. Children’s learning activity during the data collection were inquired from the teachers. This is because at that time, most of the teaching and learning were conducted online due to MCO, with various challenges. Children who always attend the online class (80%-100% of the time) was considered as active learners, those who attended lesser than that amount were regarded as less active, and children who never joined the class were considered as inactive. Information about the teachers was also obtained specifically their age and the duration of knowing the children.

Procedure

Permission from the Malaysia Ministry of Education and State Education Department were first obtained before the headmasters of various primary schools in Kelantan that have Special Education Integration Program (i.e. Program Pendidikan Khas Integrasi, PPKI) were approached. Once permission from the headmaster of each respective school was obtained, the teacher in charge of the special needs class of each respective school was approached and briefed on the research. The teachers were informed on the population of interest of the research, the content of the questionnaire, and how to complete the questionnaire. Parents were asked to complete the consent form and confidentiality was assured by associating each child with a unique identification number instead of using their names. The researcher ensured that each section of the questionnaire consisting of CBCL, STAI-C, and demographic questions were completed upon collection. Independent samples t-test was applied to compare results between different groups, and significance was considered when the p-value was less than 0.05.

Statistics

The Statistical Package for the Social Science (SPSS) version 25.0 was used for data analysis. Descriptive statistics, such as frequency, percentage, mean, standard deviation (SD) were calculated.

Results

Table 2 presents t-scores, means, and standard deviations (SD) on major component of CBCL reported by teachers. The levels of their psychological functioning were determined based on their CBCL scores which include total problems, internalizing and externalizing domains. At group level, the mean of total problems score for male students with dyslexia (Mean = 93.0; SD = 31.4), internalizing domain (Mean = 28.9; SD = 10.9), and externalizing domain (Mean = 22.7; SD = 8.23) were slightly higher compared to female students with dyslexia with the mean of 77.4 (SD = 28.5), 25.0 (SD = 10.8), 18.6 (SD = 7.95) for each respective components. This is also similar to the group of typically developing children such that the mean for total problems score (Mean = 33.5; SD = 38.5), internalizing domain (Mean = 8.59, SD = 11.5), and externalizing domain (Mean = 8.15, SD = 10.8) were also slightly higher for male students compared to the female students with the means of 28.4 (SD = 25.2), 8.52 (SD = 9.20), and 5.69 (SD = 5.89) for each respective CBCL component. Independent sample t-test was conducted for a more meaningful comparison for hypothesis testing in which CBCL score show a significant differences between children in dyslexia group and typically developing group, specifically for their psychological problem, t(88) = 8.39, p < 0.001. The mean score of children in dyslexia group was higher (Mean = 88.3; SD = 31.0) compared to typically developing group (Mean = 31.2; SD = 32.8). This shows that children with dyslexia experienced more psychological problem as compared to typically developing children. The finding supported the hypothesis that children with dyslexia have more psychological problem compared to children without dyslexia.

Table 2 The means and standard deviations of total CBCL, internalizing, and externalizing problems scores between dyslexia and typically developing groups

The result of t-test comparing internalizing problem between children in dyslexia versus typically developing groups showed significant mean difference, t(88) = 8.47, p < 0.001 between the two groups. The mean score for internalizing problem among dyslexia group was higher (Mean = 27.7; SD = 10.9) compared to their counterparts (Mean = 8.5; SD = 10.4). This shows that children with dyslexia experienced more internalizing problem as compared to children without dyslexia. The second hypothesis is accepted based on this result as children with dyslexia were found to have significantly more internalizing problems compared to typically developing children. The result from an independent-sample t-test comparing mean differences among children with dyslexia and typically developing groups for externalizing problems indicated significant differences, t(88) = 7.88, p < 0.001. The mean score for externalizing problems among children in the dyslexia group was higher (Mean = 21.5; SD = 8.2) compared to typically developing group (Mean = 7.0; SD = 8.9). This shows that children with dyslexia experienced more externalizing problems as compared to children without dyslexia. This result confirms our hypothesis that children having dyslexia display greater externalizing problems as compared to typically developing children as shown in Table 2.

Table 3 shows the t-scores, means, and SDs on sub-components of CBCL reported by teachers. Teachers' rating indicated that all sub-component showed significant mean differences between children in dyslexia group and typically developing group. The independent-sample t-test result showed significant mean differences between children in the dyslexia and typically developing groups for problem with anxiousness t(88) = 7.92, p < 0.001; withdrawn t(88) = 11.1, p < 0.001; somatic complaints, t(88) = 4.15, p < 0.001; social problems t(,88) = 8.30, p < 0.001; thought problems t(88) = 4.28, p < 0.001; attention problems t(88) = 5.74, p < 0.001; rule-breaking t(88) = 5.08, p < 0.001; aggressive behavior t(88) = 8.78, p < 0.001; and other problems t(88) = 3.94, p < 0.001. Children in the dyslexia group showed higher score for withdrawn, somatic complaints, social problems, thought problems, attention problems, rule-breaking, aggressive behavior and other problems. These indicate that children with dyslexia were more anxious, more withdrawn, presented more somatic complaints, experienced higher level of social problems, showed more aggressive behavior, and lacked of attention compared to their typically developing peers.

Table 3 The means and standard deviations of CBCL sub-component scores between dyslexia and typically developing groups

Table 4 shows that the total score of STAI-C was significantly higher in dyslexia group compared to typically developing group. The result of independent sample t-test among children in dyslexia group and typically developing group for total STAI-C indicated significant difference, t (88) = 6.81, p < 0.001. The mean STAI-C score of children in dyslexia group was higher (Mean = 40.0; SD = 10.2) compared to typically developing group (Mean = 27.6; SD = 6.97). The higher score indicates greater anxiety. This show that children having dyslexia experienced more anxiety as compared to children not having dyslexia. This result confirms our hypothesis that children having dyslexia show more anxiety as compared to children not having dyslexia.

Table 4 Mean and standard deviation of total STAI-C scores between dyslexia and typically developing groups 

Discussion

The objective of the current study is to determine the psychological functioning of children with dyslexia as compared to typically developing children. The findings of this study not only highlight the significant difference of the psychological functioning of children with dyslexia but also showed higher overall difficulties, both internalizing and externalizing, compared to their peers who do not have dyslexia. Children with dyslexia were more anxious, withdrawn, depressed and have more somatic complaints. This is consistent with Willcutt and Pennington [40] that demonstrated a significant relationship between dyslexia and internalizing problems on CBCL scale. This is further supported by Heiervang and colleagues which emphasized that children with dyslexia are more vulnerable to develop internalizing problem [41]. This may be associated with learning problems [42]. Anxiety is a frequent emotional problem reported by children with dyslexia. In the present study, children in the dyslexia group showed higher anxiety scores . Usually, children with dyslexia become fearful of academic expectations in school. These feelings are worsened by inconsistencies of their learning experience as they anticipate failure, exploring new learning demands can become anxiety provoking [43]. Anxiety causes children with dyslexia to avoid whatever frightens them [44]. Their emotional problems begin to develop when they read instructions that do not match their learning capabilities. In fact, the children with learning difficulties could be hesitant to participate in class activities due to their anxiety rather than their lack of interests in learning [45].

Another possible explanation for the increased anxiety among children with dyslexia is due to the increased in cognitive demands when they lack in the skills and capabilities required. Children with dyslexia have greater difficulty during phonological processing which is necessary for decoding words as they read [46] in addition to demands on their working memory for them to integrate information from the text which is necessary for reading comprehension [47]. Based on the cognitive load theory [48], it is suggested that the cognitive load of children with dyslexia is higher compared to typically developing children especially when teachers design lesson plans catered mainly for the latter. Their experience is amplified further during the pandemic as classes were conducted online. Teachers were told to make adjustments to their lesson so that it is suitable for open and distance learning. Even among typically developing children, online classes were found to be a difficult experience due to limited social contact, low physical activity [49], unequal access to technological devices [50], and lack of hands-on support from teachers [51]. This is supported by a systematic review that found children’s learning and school performance were significantly affected by the pandemic [52] which could also explain the increased of anxiety among children [53]. Hence, children with dyslexia are more likely to be affected by the pandemic as the materials developed for online teaching are often meant for typically developing children without considering the additional cognitive demands required by children with dyslexia. Depression is also a frequent complication in dyslexia [54] with more internalizing problems were indicated [55]. Results from the current study underline how important it is that teachers are able to identify different kinds of symptoms related to internalizing problems and to be able to refer those children for further assessment.

Many previous studies found that children with dyslexia also experienced externalizing problems [56, 57]. Prior and colleagues found that more aggressive behaviour was reported from teachers in dyslexia group compared to their peers without dyslexia [58]. This is consistent with the findings of the current study as children with dyslexia showed more aggressive behaviour and rule-breaking behaviour compared to typically developing group. This finding is also consistent regarding the associations between dyslexia and externalizing problems regardless of gender [39]. Externalizing problems include frequently getting angry, fighting, lying, and stealing to the point that teachers reported significantly more challenges managing children with dyslexia [59]. Children with dyslexia have trouble keeping up in class and may display task-avoidance behaviour such as ignoring to do homework and ignoring teacher's instruction. Chunsuwan and colleague stated that this situation usually happens when children enter primary school which focuses more on reading and writing practices. Avoidance behaviour may also result in receiving negative feedback, such as scolding and punishment by teachers, which will increase children's aggressive behavior [56]. The externalizing problems can become worse when teachers are not aware of the main cause of the problems.

The results also showed that students with dyslexia have more attention difficulties compared to their typically developing peers which is consistent with many past findings [60,61,62]. This could be explained by neuropsychological profile of students with dyslexia being similar to children with Attention Deficit-Hyperactivity Disorder (ADHD) specifically their processing speed, shifting, planning and verbal fluency [60]. Flexibility of attention is necessary for shifting focus from word to word during reading and ability to pay attention to several things at once [42]. However, there are differences regarding the manifestations of difficulties since children with ADHD might seem distracted because it is difficult for them to pay attention, while children with dyslexia might appear distracted because reading requires a great deal of effort [62]. Therefore, it is important for teachers to determine the provisional problems and differentiate them from the comorbidities.

Overall, the current study provides empirical evidence regarding the psychological functioning of children with dyslexia. They are more at risk of being depressed, more anxious, and have behavioral problems compared to their peers. This means that there is a need to focus on psychological support for children with dyslexia in addition to academic intervention.

Conclusion

There is a need for a multidisciplinary approach that integrates emotional needs assessment into the academic intervention for children with dyslexia. Increasing awareness and understanding of dyslexia can assist with early identification and timely initiation of appropriate psychological interventions. Children with dyslexia benefit significantly when they receive consistent and supportive encouragement early in life. Teachers play a pivotal role in creating a supportive environment by maintaining open communication and teaching children how to express their emotions effectively. Schools can also implement academic accommodations, such as extended time for tasks and additional practice activities to support the learning needs of children with dyslexia. Interventions such as cognitive behavior therapy and psychoeducation have shown promise in enhancing the psychological well-being of vulnerable populations [63]. Therefore, similar interventions can also be designed or developed for children with dyslexia due to their unique challenges. The availability of both academic intervention and psychological intervention will ensure that a more holistic support system can be established for children with dyslexia.

Limitation of the study

One limitation of the current study is the limited generalizability of the findings. This is because the study's objective was to conduct a comparative study rather than to determine interactions between variables of interest. Consequently, the sample size required for the analysis was smaller. Future studies can focus on alternative analysis such as correlation or regression, using a larger sample size to enhance the generalizability of the results. Additionally, the quality of the relationship between teachers and students could act as a confounding variable. Future studies can consider using scales to assess whether there is a significant difference in the quality teacher-student relationship for children with dyslexia compared to typically developing children. Although the study's data were collected during the COVID-19 pandemic, which may present as a limitation, it also offers empirical evidence of the challenges faced by children with dyslexia during sudden changes in the learning environment. The findings of the current study may not be generalized for situation outside the pandemic but it can provide an extension of previous findings on how children with dyslexia experienced greater anxiety compared to typically developing children when there is no health crisis [40, 41, 43, 44] versus during the occurrence of a health crisis.

Future research and implication

The current findings suggest that children with dyslexia are at an increased risk of emotional and behavioral problems, but most existing studies focuses predominantly on improving academic performance . Future studies should explore the relationship between psychological problems and academic performance to better understand the risk and protective factors for the mental health of children with dyslexia. A collaborative and holistic approach, involving teachers, parents, and mental health professionals are needed to support the psychological well-being of these children, aiming to prevent the escalation of emotional difficulties and, in some cases, the onset of mental health disorders.