Reading Solutions

bioRxiv 2020.03.09.983197

Oculomotor-related measures but not distance visual acuity are predictive of reading ability in first graders

Authors: Portnoy, A1, and S Gilaie-Dotan1,2 (1 School of Optometry and Vision Science, Faculty of Life Science, Bar Ilan University, Ramat Gan, Israel; 2 Institute of Cognitive Neuroscience, UCL, London, UK)
Publication: bioRxiv 2020.03.09.983197
Date: March 2020
Tags: Oculomotor,Visual Acuity,

Vision screening in junior schools around the globe are often limited to distance visual acuity (dVA). Oculomotor dysfunction (OMD) is an umbrella term that includes abnormalities in comfortable and accurate control of the oculomotor system (fixation, pursuits and saccades) and can exist despite normal dVA. Since we assumed that a basic prerequisite for successful reading is that the ocular sensory-motor functions perform in flawless harmony with effortless automaticity, we hypothesized that OMD but not dVA would have profound effect on comfortable and efficient acquisition of effective reading skills. Consequently, we retrospectively compared independently obtained (double blind) reading evaluations and extensive optometric screening examinations of a class of 28 first graders. We found, as we hypothesized, that performance on optometric oculomotor tests, but not dVA, were predictive of reading test performance (both speed and accuracy) according to the standardized national reading norms. Our results suggest reevaluating the effectiveness of dVA as a marker of visual readiness for scholastic achievements. We propose including OMD related assessments as part of a paradigm shift in both vision screening in early readers as well as potential treatment protocols for those pupils struggling to acquire efficient reading skills.

Summary Points:

  • According to 2017 data, only 35% of children starting fourth grade in the US had reading skills that were proficient or above proficient level relative to their age.
  • The prevalence of oculomotor dysfunction (OMD) in school-aged, proficient readers is estimated to be 22-24%, compared to as high as 95% in child populations diagnosed with a reading difficulty.
  • The study found that K-D Test accuracy and speed was significantly predictive of reading performance. Better K-D Test accuracy scores were associated with higher reading accuracy performance. Individuals with oculomotor deficits have been shown to benefit from oculomotor-targeted treatments.
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Applied Neuropsychology

Evaluating the Construct Validity of the King-Devick Test in a Psychological Outpatient Clinical Sample

Authors: John P. K. Bernstein, Scott Roye , Daniel Weitzner, and Matthew Calamia (Department of Psychology, Louisiana State University, Baton Rouge, LA, USA)
Publication: Applied Neuropsychology
Date: October 2019
Tags:

The King–Devick test (K–D) has demonstrated sensitivity as a screener measure of ocular motor and cognitive problems. Despite its empirical support in the assessment of patients with certain injuries and disorders (e.g., concussion, reading disorders), less is known about the construct validity of the K–D. This study examined this topic in an outpatient, diagnostically heterogeneous clinical sample. A total of 70 individuals seen for an outpatient psychoeducational evaluation completed the K–D in addition to measures of intellectual abilities, speeded reading ability, simple and sustained attention, and executive functioning. Pearson correlation coefficients revealed that poorer K–D performance was associated with poorer processing speed, speeded reading ability and response time to target stimuli (r = .26–.31, p < .05). K–D performance was unrelated to other intellectual abilities, other aspects of attention, or executive functioning (all p > .05). Results suggest that the K–D demonstrates good convergent and discriminant validity in a heterogeneous outpatient clinical sample including individuals with attention-deficit hyperactivity disorder, specific learning disorders, and a number of different depressive and anxiety disorders. Findings support its wider use as a measure of reading ability and processing speed in clinical contexts.

Summary Points:

  • Poorer performance on the King-Devick test was associated with poorer processing speed, speeded reading ability and response time to target stimuli.
  • The K-D test demonstrated good convergence and discriminant validity in this outpatient, diagnostically heterogeneous clinical sample.
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Poster Presentation at COVD 2019 Annual Conference

Successful Implementation of the King-Devick Reading Acceleration Program by School Staff

Authors: Talaber, A.1, Villar, K. (1 King-Devick Technologies, Inc., Oakbrook Terrace, IL)
Publication: Poster Presentation at COVD 2019 Annual Conference
Date: October 2019
Tags: Reading,

Introduction:

Developmental vision disorders are common in children with reading difficulties. The King-Devick Reading Acceleration Program (K-D RAP) is a computerized, eye movement training program. This study aimed to evaluate the implementation of K-D RAP by school staff and the effect on student reading outcomes.

Methods:

Students (n=34) were enrolled from two 3rd grade classes in West Memphis. Teachers and teacher’s aides supervised students during in-class K-D RAP intervention 12 minutes/day, 5 days/week for six weeks. Standard reading assessments using Weschler Individual Achievement Test III (WIAT), the Developmental Reading Assessment (DRA) and the King-Devick Test were administered before and after the K-D RAP intervention.

Results:

Median post-KD RAP reading scores significantly improved as compared to pre-KD RAP (WIAT fluency: 15th PR (84 SS) to 25th PR (89.5 SS), p = 0.0005; WIAT comprehension: 24th PR (89.5 SS) to 34th PR (94 SS), p = 0.015; DRA fluency 9% improvement, p = 0.024; DRA comprehension 7% improvement, p = 0.014). Overall, students improved from a Below Average to Average standard reading levels. Similarly, K-D Test performance improved (speed: 106s vs. 87s; accuracy: 25 errors vs. 6 errors), demonstrating faster and more accurate saccadic function.

Conclusion:

K-D RAP was successfully incorporated into the classroom by school staff with significant gains in student reading performance. Students and schools would benefit from incorporating K-D RAP into the curriculum to enhance early reading performance and overall academic achievement.

Summary Points:

  • Teachers and teachers’ aides supervised K-D RAP in the classroom, and the students performed K-D RAP 12 minutes daily for 6 weeks.
  • Overall student reading performance increased 10 percentile rank points in fluency (15th to 25th PR) and comprehension (24th to 34th PR).
  • The school district’s reading assessments demonstrated significant improvements when comparing pre- to post-intervention with K-D RAP as well.
  • Similar to prior K-D RAP studies, significant reading performance gains were achieved.
Vision Development & Rehabilitation; Volume 5, Issue 3

The King-Devick Reading Acceleration Program Significantly Improves Reading Performance in Students with Dyslexia

Authors: Alexandra Talaber, OD, FCOVD, FAAO, Jennifer Wethe, PhD, Danielle Leong, OD, PhD
Publication: Vision Development & Rehabilitation; Volume 5, Issue 3
Date: September 2019
Tags: Dyslexia,Reading,Students,

Background:

Reading is a complex task and for students who are not proficient in reading, intervention and remediation is frequently necessitated. Previous literature has shown support for the inclusion of in-school oculomotor training using the King-Devick Reading Acceleration Program (K-D RAP) to supplement current reading curriculums. The aim of this study was to evaluate the effect of the K-D RAP intervention in students with dyslexia.

Methods:

Participants with dyslexia diagnosed by a licensed professional were recruited and enrolled (n=7). Participants performed a total of six hours of K-D RAP intervention which was parent-supervised in their homes. Reading fluency and the King-Devick Eye Movement Test for Reading was administered before and after the intervention.

Results:

Participants demonstrated a 14 WCPM increase in fluency following intervention with K-D RAP, which was significant (50 to 64 WCPM; p = 0.0178). Greater reading fluency improvements were observed in younger participants compared to older participants (under age 10: 51.2% vs. ages 10 and above: 3.2% improvement; p = 0.0339). Participants with other learning disability diagnoses in addition to dyslexia were likely to impact progress in reading achievements.

Conclusion:

Similar to prior research of randomized, controlled trials examining the effect of K-D RAP in the general school curriculum, students with dyslexia in this study achieved significant reading gains following six hours of practice. There is an urgency for implementing K-D RAP, as findings indicate that older students do not improve to the same degree as younger students, which is coincident with research demonstrating earlier intervention is more effective for reading enhancement.

Summary Points:

  • Dyslexia is frequently associated with oculomotor, or eye movement, dysfunction.
  • Children with dyslexia achieved significant reading fluency improvement after improving oculomotor skills with K-D RAP.
  • Students with reading ability 4th grade and lower improve to greater degrees than students with reading ability over 4th grade, therefore, early implementation of K-D RAP is an important consideration.
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Journal of Neurological Sciences. 2019

King-Devick Computerized Neurocognitive Test Scores in Professional Football Players with Learning and Attentional Disabilities

Authors: Mrazik M, Naudi D, Borza C, Kobitowich T, Simran S
Publication: Journal of Neurological Sciences. 2019
Date: March 2019
Tags: Football,Learning Disability,Professional Athletes,

Objective

This study examined outcomes from the King Devick (K-D) in athletes with Learning Disabilities (LD) and attention disorders (ADHD).

Methods

A total of 574 professional football players from the Canadian Football League (CFL) completed baseline evaluations with computerized neurocognitive testing (CNT) prior to the 2016 competitive season. Player age, education, history of concussion, LD, and ADHD were analyzed for K-D and Immediate Post Concussion Assessment and Cognitive Testing (ImPACT) performance. A series of analyses of co-variance (ANCOVA’s) were used to compare participants with a history of LD and ADHD with history of concussion as a co-variate.

Results

Approximately 5% of participants reported a diagnosed history of LD and 13% with ADHD. Performance on the K-D test was not significantly correlated with age, education, or history of concussion but was significantly correlated with history of LD and ADHD. Participants with LD performed approximately 6.9 seconds slower on the K-D test (t[563] = 4.70, p. = 0.0003) and participants with ADHD were approximately 2 seconds slower (t[572] = 2.04, p. = 0.04).

Conclusions

Results indicated that players with a history of diagnosed LD and ADHD performed slower on the K-D test in comparison to athletes with no history of diagnoses. The results of this study underscore the importance of recognizing individualized outcomes when using the K-D.

Summary Points

  • Performance on the K-D test was significantly correlated with history of LD and ADHD.
  • Participants with a history of LD performed approximately 6.9 seconds slower on the K-D test, a result consistent with findings of slower K-D scores in LD samples.
  • Players with a history of ADHD presented with statistically significant slower performance (1.9 seconds slower) when compared to the non-ADHD group.
  • There was no significant effect for history of concussion on K-D baseline score.
  • The K-D Test was significantly correlated with Visual Motor Processing, Visual Memory, and Reaction Time, however R-squared values were low suggesting little overlap between the cognitive abilities suggesting that the K-D Test adds unique information to the clinical outcomes associated with concussion.
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Annals of Biomedical Engineering. 2018.

Impact of Factors that Affect Reading Skill Level on King–Devick Baseline Performance Time

Authors: Chrisman SPD, Harmon KG, Schmidt JD, Kaminski TW, Buckley TA, Kontos AP, Clugston JR, McCrea M, McAllister T, Broglio SP, Ortega J
Publication: Annals of Biomedical Engineering. 2018.
Date: November 2018
Tags: Collegiate Athletes,Language,Learning Disabilities,Learning Disability,Reading,Sports-Related Concussion,

The King–Devick (K–D) test is often used as part of a multimodal assessment to screen for sport-related concussion. However, the test involves reading numbers, and little is known about variation in baseline performance on the K–D by reading skill level. We conducted a cross-sectional study analyzing data from the Concussion Assessment, Research and Education (CARE) Consortium to assess differences in baseline performance on the K–D associated with factors that impact reading skill level (learning disorder [LD] and primary home language other than English [PHLOTE]), while controlling for covariates (gender, type of sport, attentional issues, history of concussion and modality of administration). We had a sample of 2311 student-athletes (47% female), and multivariate regression indicated an average K–D performance time of 40.4 s. Presence of LD was associated with a 3.3 s slower K–D time (95% CI 1.9–4.7, p < 0.001), and PHLOTE was associated with a 2.6 s slower K–D time (95% CI 1.2–4.0, p < 0.001), after controlling for other covariates. These results suggest caution in the use of normative data with the K–D. Future studies should explore the impact of factors associated with reading skill level on sensitivity of the K–D in detecting concussion.

Summary Points:

  • The King–Devick (K–D) test has been used as a rapid sideline screening test, since it evaluates complex cognitive function including visual-motor coordination, language function and attention, and thus sensitive to concussion and other brain injury.
  • Multiple regions of the brain are necessary to complete the K–D test. Motor function is involved, particularly saccades (scanning from left to right across the page in a coordinated fashion) and accommodation (contracting the eye muscles in order to focus on and read the numbers). The amplitude of saccadic eye movement is associated with the oculomotor nuclei, whereas the direction of these eye movements is associated with the reticular formation. Individuals completing the K–D must also recognize single digit numbers, a function that has been localized to the inferior temporal gyrus. They must then associate each number with the English word for that number and contract the oral musculature to say the word for each number aloud, which involves both language comprehension (Wernicke’s area) and language production (Broca’s area).
  • Multiple regression analysis including presence of LD and PHLOTE (primary home language other than English) in addition to other covariates had the best model fit, and indicated a 3.3 s longer K–D performance time for those with LD (95% CI 1.9–4.7, p < 0.001) and 2.6 s longer K–D time (95% CI 1.2–4.0, p < 0.001) for those with PHLOTE.
  • These results suggest caution in using normative data with the K–D test, as these factors may result in false positive findings in the absence of concussion.
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Vis Dev Rehabil. 2017;3(4)

The Effect of the King-Devick Reading Acceleration Program on Reading Fluency and Comprehension: A Summary of Randomized Clinical Trials

Authors: Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Halker-Singh RB, Bogle JM, Mandrekar J, Talaber A, Leong D
Publication: Vis Dev Rehabil. 2017;3(4)
Date: December 2017
Tags:

Background: Reading performance is essential to a child’s academic success. Reading is a complex task involving the integration of language, attention, information processing including eye movements. Efficient eye movements provide a physical foundation for proficient reading and these skills can be improved as multiple studies have reported successful outcomes following training. Data from these studies are summarized and presented to examine the effect of the training program across a wide demographic and large student population. Subgroup analyses further lend insight to ideal timing and length of training.

Methods: Data from five investigations of in-school training programs were combined and analyzed. Study participants were randomized into treatment or control groups. Students 1st through 4th grade (n=611, 7.0 ± 0.8 years) underwent eighteen, 20-minute sessions utilizing King-Devick (K-D) Reading Acceleration Program (RAP). Reading fluency and comprehension was assessed pre- and post-treatment.

Results: The treatment group had significantly greater improvement compared to the control group in fluency (8.9% vs. 5.9%, p<0.001) and comprehension (9.1% vs. 3.1%, p<0.001). A separate group of high-needs students (n=111) also improved significantly in fluency (p<0.001) and comprehension (p<0.001). An extra-training group, who received an average of 11 additional treatment sessions, improved significantly in fluency and comprehension following extra-training (p=0.003, p=0.013). There was a greater improvement in reading comprehension for students receiving intervention in the fall as compared to the spring (10.9% vs 8.1%, p<0.001).

Conclusions: Improving reading skills in youth is essential to building foundations for future academic success. Efficient eye movements are one necessary component of proficient reading that integrate with visual processing, word decoding and attention span. K-D RAP improves aspects of reading that are not currently addressed in schools. Based on the positive reading outcomes there is increasing evidence supporting the inclusion of teaching the physical act of reading in the early education curriculum nation-wide.

Summary Points:

  • The treatment group had significantly greater improvement compared to the control group in fluency (8.9% vs. 5.9%, p<0.001) and comprehension (9.1% vs. 3.1%, p<0.001).
  • A separate group of high-needs students (n=111) also improved significantly in fluency (p<0.001) and comprehension (p<0.001).
  • An extra-training group, who received an average of 11 additional treatment sessions, improved significantly in fluency and comprehension following extra-training (p=0.003, p=0.013).
  • There was a greater improvement in reading comprehension for students receiving intervention in the fall as compared to the spring (10.9% vs 8.1%, p<0.001).
  • During the training, out of 611 students, 97.6% improved in reading fluency and 90.2% improved in reading comprehension.
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Br J Sports Med. 2017; 51(11):A81-82

Pre-season Concussion Testing in High School Students with Academic Difficulties or Attention Deficit Hyperactivity Disorder

Authors: Herceg M, Wojtowicz M, Iverson G
Publication: Br J Sports Med. 2017; 51(11):A81-82
Date: June 2017
Tags: ADHD,Learning Disability,

Objective: Learning disabilities and/or ADHD are considered to be important risk factors or modifiers for concussion assessment and management. The purpose of this study was to examine cognition and symptom reporting in high school students with academic difficulties or ADHD and compare to those without at baseline.

Design: Retrospective analysis of three measures routinely given as part of a high school yearly concussion baseline protocol. Setting: The library of a high school in Westchester County, NY.

Participants: A sample of 143 high school students who participate in collision/contact sports [Age M (SD)=15.4 (1.2); Boys=78, 54.5%] completed baseline testing.

Main results: Non-parametric tests were used because of violations of normality. High school students with academic difficulties or ADHD (n=21) were compared to controls (n=122) on King- Devick, SAC, ImPACT Cognitive Composite scores, and Total Symptom ratings. Students with LD or ADHD performed significantly more poorly on King-Devick (p=0.003; d=0.79), Visual Motor Speed Composite of ImPACT (p=0.007; d=0.79), and reported more symptoms at baseline on the Post-Concussion Scale (p=0.005; d=0.59). No significant differences found between groups on SAC (p=0.11; d=0.36) or ImPACT Verbal Memory (p=0.54; d=0.16), Visual Memory (p=0.20; d=0.26), or Reaction Time (p=0.14; d=0.55) Composites.

Conclusions To our knowledge this is the first study to examine performance on three different baseline measures. High school students with academic difficulties or ADHD performed more poorly on King-Devick, the Visual Motor Speed Composite of ImPACT, and reported more symptoms at baseline. Findings suggest these students need to be monitored for specific post injury changes.

Summary Points:

  • High school athletes with learning disability and/or ADHD performed worse on K-D Test at baseline compared to controls.
  • This highlights the importance of establishing an individual pre-injury baseline for comparison during concussion screening and recovery monitoring.
  • Additionally, the study supports a prior study demonstrating the eye movements may be impacted by neurological changes associated with ADHD.
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Presentation at the American Medical Society for Sports Medicine 2017 Annual Meeting

Visual Performance Testing in Children and Adolescents with ADHD

Authors: Karbinovskaya Y, Mueller B, Wells J, Baner N, Davies K, Moehringer N, Hasanj L, Leong D, Galetta SL, Jacobs B, Balcer LJ
Publication: Presentation at the American Medical Society for Sports Medicine 2017 Annual Meeting
Date: April 2017
Tags: ADHD,

Purpose: In the United States, ADHD is estimated to affect 5.4 million children between 6-17 years old. It is the most prevalent pediatric neurodevelopmental disorder. The King-Devick (K-D) test is a vision-based assessment of rapid number naming that requires saccades and visual processing. In sideline testing of young athletes with concussions, the K-D test demonstrated higher score times after a concussive injury as compared to the baseline pre-season scores. ADHD, like concussion and mild TBI, has been linked with visual pathway dysfunction. Our investigation looked at whether children with ADHD scored worse or similar to age-matched controls.

Methods and Study Design: Our prospective study looked at children with ADHD and their age-matched controls in patients diagnosed with ADHD between ages 5-21. Analysis compared K-D scores of patients with ADHD to those scores of student-athlete controls matched for age and gender. Data analysis was done with logistic regression, ROC curves and t-test.

Results: Among 134 participants in this study, ADHD vs. control was significantly associated with higher K-D scores (p<0.001). K-D showed a greater capacity to distinguish ADHD in participants older than 11 years of age when compared to controls. Participants with a diagnosis of ADHD required an average of 14 seconds longer to complete the K-D test compared to controls. Stimulant medication use was not associated with differences in K-D scores within the ADHD group.

Conclusions: This study illustrates that visual pathways might be utilized differently in children and young adults with ADHD compared to controls.

Significance of Findings: Given the difference in baseline K-D scores of patients with ADHD, this study can have implications for assessing concussions. Different baseline norms may be needed in the management of concussions in athletes with ADHD.

Summary Points:

  • Visual pathways might be utilized differently in children and young adults with ADHD compared to controls.
  • Norms should not be used for sideline concussion screening as variables such as age and ADHD diagnosis can affect performance. Comparison against individual baseline should be used and is supported by the literature.
  • Caution should be used when considering used of baseline norms in the clinical management of concussion.
Optometry & Visual Performance: Volume 4 | Issue 6

A Comparison of Performance on the NYSOA King-Devick Test between Mexican and American School-aged Children

Authors: Benjamin Konynenbelt, OD, Southern College of Optometry, Memphis, Tennessee; Paul Harris, OD, Southern College of Optometry, Memphis, Tennessee; Francisco Pérez Robles, LO, Torreon, Coahuila, Mexico
Publication: Optometry & Visual Performance: Volume 4 | Issue 6
Date: December 2016
Tags: Reading,Saccadic,

Background:

The King-Devick Test has long been used to screen reading eye movements in school-aged children. A normative database has been developed for use in the United States (U.S.), but there is limited information on its application internationally. The purpose of the current study is to compare the performance on the King-Devick Test of Mexican school-aged children to the established norms of U.S. children.

Methods:

Six- (n=33), nine- (n=28), twelve- (n=33), and fourteen-year-old (n=26) children from six geographically-separate Mexican states were enrolled. Subjects completed subtests I-III of the King-Devick Test in a seated position under normal room illumination. Each subtest was timed and behavioral characteristics were assessed. Performance of each age group was compared to the U.S. database using simple, paired t-tests with a probability factor of 0.05.

Results:

There was a statistically significant difference in performance between 14-year-old children in the Mexican and U.S. group (p=0.003). No significant difference was found in the respective comparisons between six-, nine-, and twelve-year-old Mexican and U.S. children (p>0.05).

Conclusion:

Performance on the King-Devick Test is similar between Mexican and U.S. children. It would be appropriate to use this test in a similar manner for evaluating reading eye movements in Mexican, school-aged children.

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J Child Neurol 2017;32(1)

The Effect of In-School Saccadic Training on Reading Fluency and Comprehension in First and Second Grade Students: A Randomized Controlled Trial

Authors: Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker-Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D
Publication: J Child Neurol 2017;32(1)
Date: October 2016
Tags:

Efficient eye movements provide a physical foundation for proficient reading skills. We investigated the effect of in-school saccadic training on reading performance. In this cross-over design, study participants (n=327, 165 males; mean age (SD): 7yrs-6mos (1yr-1mo)) were randomized into treatment and control groups then underwent eighteen, 20-minute training sessions over five weeks utilizing King-Devick Reading Acceleration Program Software. Pre- and post-treatment reading assessments included: fluency, comprehension, and rapid number naming performance. The treatment group had significantly greater improvement compared to the control group in fluency (6.2% vs. 3.6%, p=0.0277) and comprehension (7.5% vs. 1.5%, p=0.0002). The high-needs student group significantly improved in fluency (p<0.001) and comprehension (p<0.001). We hypothesize these improvements to be attributed to the repetitive practice of reading-related eye movements, shifting visuospatial attention, and visual processing. Consideration should be given to teaching the physical act of reading within the early education curriculum.

Summary Points:

  • Students in 1st and 2nd grade were enrolled in 6 weeks of the King-Devick Reading Acceleration Program.
  • The treatment group had significantly greater improvement compared to the control group in fluency and comprehension.
  • A subgroup analysis was performed on high needs students, who were students with an active IEP or in reading recovery Overall, high needs students went from 26th to 40th national percentile rank in reading fluency and from 40th to 56th in comprehension after RAP.
  • The King-Devick Test, an eye movement test used for reading screening, may be used to predict below-average reading
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Presented at the American Academy of Optometry 2016 Annual Meeting

Reading Fluency Measures with Single Word Presentation Verses Left-to-Right Reading in Third Grade Students

Authors: Wethe J, Leong D, Talaber A
Publication: Presented at the American Academy of Optometry 2016 Annual Meeting
Date: June 2016
Tags:

Objective: Accurate and efficient eye movements are an important aspect to a child’s reading performance. Poor readers demonstrate higher rates of eye movement disorders, which may negatively impact reading. Saccadic eye movements direct the eyes to the next word while reading. Single word presentation reading presents each word centered in the screen. The purpose of this study was to measure reading fluency for students using single word presentation reading and traditional left-to-right reading. Methods: In this randomized study, participants (n=22) read 3rd Grade Scholastic Reading Fluency Passages using single word presentation and left-to-right reading. Left-to-right reading was measured by adding the total number of words read correctly in one minute (WCPM). Reading fluency was measured using single word presentation by adjusting the speed of presentation to the maximum speed the student stated words clearly without errors for one minute (WCPM). Students answered three reading comprehension questions following each reading passage. Results: Students achieved significantly higher reading fluency scores when reading with single word presentation compared with left-to-right reading (mean (SD), 154 (47) WCPM vs 125 (46) WCPM, p<0.001, Wilcoxon signed-rank test). Reading comprehension scores were slightly higher when reading with single word presentation verses left-to-right reading (92% (18) vs 88% (17)), however this was not statistically significant (p=0.335). On average, students read 28.8 more words per minute while reading with single word presentation compared with left-to-right reading. Conclusion: This study found that single word presentation reading may be a more efficient method of reading and maintain or improve reading comprehension. Single word presentation technology should be considered as an addition to current reading methods.

Summary Points:

  • Single word presentation reading may be a more efficient method of reading and maintain or improve reading comprehension.
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Presented at the American Academy of Optometry 2016 Annual Meeting

The Effect of the King-Devick Reading Acceleration Program on Reading Fluency and Comprehension in Grade School Students: A Randomized Controlled Trial

Authors: Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D
Publication: Presented at the American Academy of Optometry 2016 Annual Meeting
Date: June 2016
Tags:

Objective. The King-Devick Reading Acceleration Program (RAP) is an eye movement training program aimed at improving reading performance for grade school students. King-Devick RAP was implemented in the fall season in the first grade curriculum in order to evaluate its effectiveness on reading performance.

Methods. In this randomized, controlled, cross-over design, study participants (n=134, 76 males) were allocated into treatment and control groups in a two-to-one ratio and underwent eighteen, 20-minute training sessions over six weeks utilizing King-Devick Reading Acceleration Program Software. The treatment group read aloud single, randomized numerical targets zero through nine that were presented in a left to right direction. The control group read aloud single, randomized numeric targets, positioned in the center of the screen which did not change position. The speed of presentation was gradually increased over time as the subject progressed through training. Pre- and post-treatment reading assessments were performed, including the Wechsler Individual Achievement Test Third Edition (WIAT) Reading Fluency and Comprehension Tests and the King-Devick Test.

Results. The treatment group improved significantly compared with the control group in reading fluency (14% vs 11%, p=0.015) and reading comprehension (12% vs 5%, p<0.001). The high needs student subgroup was analyzed as a separate group and consisted of students with an Individualized Educational Plan, enrolled in reading assistance programs, or were English-Language Learners. The high-needs student group (n=25) significantly improved in pre- to post-treatment assessments in both reading fluency (14%, p<0.001) and comprehension (10%, p<0.001).

Conclusion. The K-D RAP program significantly improved reading fluency and comprehension over the course of six weeks of in-school training. This study further supports teaching the physical act of reading in the early education curriculum.

Summary Points:

  • The King-Devick Reading Acceleration Program significantly improved reading fluency and comprehension over the course of 6 weeks (6 hours) of in-school training, which was flexibly incorporated into the daily classroom schedule.
  • Efficient eye movements are one necessary component of proficient reading that integrate with visual processing, word decoding, and attention span; cognitive processing also contributes to successful reading.
  • The King-Devick Reading Acceleration Program improves aspects of reading that are not currently addressed in schools.
  • Based on the positive reading outcomes found in this study and prior studies, there is increasing evidence to support the inclusion of teaching the physical act of reading in the early education curriculum.
Read More
Vis Dev Rehabil. 2015;1(2):130-134

Oculomotor Training using King-Devick Remediation Elementary School Reading Fluency Outcomes

Authors: Wethe J, Leong D, PangY, Weil R
Publication: Vis Dev Rehabil. 2015;1(2):130-134
Date: August 2015
Tags:

Oculomotor training has been associated with improvements in reading fluency, but the physical act of reading is not typically taught in schools. The purpose of this retrospective study was to examine reading fluency outcomes in elementary students following oculomotor training. Methods: Pre- and post-training Scholastic Reading fluency benchmarks were reviewed for nine students (Grade1 through 4) who had undergone 6-week in-school training using King-Devick (K-D) Remediation software. Results: All students demonstrated improvement in reading fluency scores following training and this was statistically significant (p=0.008, Wilcoxon signed-rank). Conclusion: Findings support prior research that oculomotor training results in improved reading fluency.

Summary Points:

  • Students, grades 1st through 4th participated in 6 weeks of the King-Devick Reading Acceleration Program and underwent pre- and post- standardized reading fluency testing in this pilot
  • All students improved in reading fluency after the course of the training.
  • The improvement in reading fluency may be attributed to the rigorous practice of eye movements (saccades) and shifts in visuospatial attention, which are necessary for proficient
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Neurology Apr 2015, 84 (14 Supplement) P1.330

Visual Performance Testing in Children with Attention Deficit Hyperactivity Disorder

Authors: Mueller B, Wells J, Baner N, Davies K, Moehringer N, Hasanj L, Leong D, Galetta SL, Balcer LJ
Publication: Neurology Apr 2015, 84 (14 Supplement) P1.330
Date: April 2015
Tags: ADHD,Youth Athletes,

BACKGROUND: ADHD is the most prevalent pediatric neurodevelopment disorder. In the United States, it is estimated that 5.4 million children 6 and 17 years of age (or 9.5% of U.S. children) have received an ADHD diagnosis. The King-Devick (K-D) test is a vision-based test of rapid number naming that requires saccades and visual processing. In sideline studies of youth and collegiate athletes with concussion, the K-D test consistently demonstrates higher (worse) time scores post-injury compared to pre-season baseline scores. There is growing evidence that, like concussion and mild traumatic brain injury, ADHD may be associated with visual pathway dysfunction.

PURPOSE: Using the King-Devick (K-D) test, a vision-based test of rapid number naming that requires saccades and visual processing. We investigated whether children with ADHD has worse scores compared to similar aged controls.

METHODS: Design: Prospective study of children with ADHD (diagnosed by Conners Scale and NYU pediatric neurologist) and age-matched controls. Participants: Patients diagnosed with ADHD (5-21 years of age) seeking care from the NYU Neurology Faculty Group Practice and Child Study Center. Analyses compared K-D scores of patients with ADHD to those of pre-season baseline scores for student-athletes controls category matched for age and gender. King-Devick Test: a vision-based measure of rapid number naming that varies the spacing between numbers on successive cards.

RESULTS: Among 134 participants in this study, ADHD vs. control status was significantly associated with higher K-D test time scores (p<0.001, logistic regression models, accounting for age). K-D showed a greater capacity to distinguish ADHD vs. control groups in youths older than 11 years of age (ROC curve areas from logistic regression models was, 0.55 for youths ≤11 years of age and 0.79 for youths ≥11 years of age). Patients with ADHD took an average of 14 seconds longer to complete the K-D test, compared to control youth (p<0.001, two-sample t-test). Use of stimulant medications was not associated with differences in K-D time scores within the cohort of patients with ADHD (p > 0.05, best KD trial of ADHD on Rx vs. best KD trial of ADHD off Rx).

CONCLUSIONS: Visual pathways may perform or be utilized differently in youths with ADHD compared to controls. This alteration in visual performance on the K-D test in youths with ADHD is likely due to the widespread distribution of brain pathways devoted to vision (approximately 50% of the brain’s circuits). The limited capacity of the K-D to distinguish ADHD in youths younger than 11 years of age may be due to variations in reading ability in this age group. Use of stimulant medication was not associated with altered K-D test performance.

Summary Points:

  • Investigated if there was a difference in the King-Devick Test of rapid number naming in subjects (ages 5-21) with ADHD verses those without.
  • Subjects with ADHD showed significantly worse K-D scores compared to the controls.
  • The K-D Test demonstrated a greater capacity to distinguish ADHD vs. control groups in youths older than 11 years of age (ROC curve areas from logistic regression models was, 0.55 for youths ≤11 years of age and 0.79 for youths ≥11 years of age).
  • Patients with ADHD took an average of 14 seconds longer to complete the K-D test, compared to control youth (p<0.001, two-sample t-test).
  • ADHD medication was not associated with differences in K-D scores within the cohort.
  • Since ADHD is a neuro-development disorder and more than 50% of the brain is devoted to vision, the K-D Test highlights aspects of vision which may be affected by ADHD.
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Clin Pediatr 2014;53(9)

The Effect of Saccadic Training on Early Reading Fluency

Authors: Leong DF, Master CL, Messner LV, PangY, Smith C, Starling AJ
Publication: Clin Pediatr 2014;53(9)
Date: May 2014
Tags:

Background: Eye movements are necessary for the physical act of reading and have been shown to relate to underlying cognitive and visuoattentional processes during reading. The purpose of this study was to determine the effect of saccadic training using the King-Devick remediation software on reading fluency.

Methods: In this prospective, single-blinded, randomized, crossover trial, a cohort of elementary students received standardized reading fluency testing pre- and posttreatment. Treatment consisted of in-school training 20 minutes per day, 3 days per week for 6 weeks.

Results: The treatment group had significantly higher reading fluency scores after treatment (P < .001), and posttreatment scores were significantly higher than the control group (P < .005).

Conclusions: Saccadic training can significantly improve reading fluency. We hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.

Summary Points:

  • Students in grades 1st through 3rd enrolled in a 6-week long Reading Remediation program to train reading-related eye
  • King-Devick Reading Remediation significantly improved reading
  • At the 1-year follow-up reading fluency scores remained significantly higher than before K-D
  • K-D Remediation shows promising results in improving early reading
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Presentation at College of Optometrists in Vision Development 2014 Annual Meeting

Oculomotor Training using KD Remediation Improves Reading Fluency

Authors: Winters B
Publication: Presentation at College of Optometrists in Vision Development 2014 Annual Meeting
Date: April 2014
Tags:

The purpose of this study was to determine if adding oculomotor training, using King-Devick (K-D) Remediation software, to an existing high school reading program would improve reading fluency outcomes. In this prospective, single-blinded, cross-over trial, of high school students (n=53) in grades 9 and 10 enrolled in the school’s 12-week supplemental reading course, all students received reading intervention using Scholastic’s Reading 180 system (New York, NY). Students were randomized by classroom into 3 groups based on their initial training condition (K-D Remediation, Placebo & Scholastic Only) and pre- and post-remediation measures were performed using the K-D Test and   Reading Curriculum-Based Measurement (RCBM) reading fluency test. There was a significantly greater percentage improvement in reading fluency scores (WCPM) with combined K-D Remediation compared to reading intervention with Scholastic Only (7.54% vs. 3.59%, p = 0.03). Over the entire training period there was an average increase of 9.88 WCPM during sessions with K-D Remediation, 4.7 WCPM with Scholastic Only and 2.78 WCPM during Placebo. Expected improvement of a successful reading program is an increase of 5 WCPM. In this study, reading intervention coupled with oculomotor training using K-D Remediation, resulted in nearly double the expected reading fluency improvement.

Summary Points:

  • This investigation examined the effect of adding the K-D Reading Acceleration Program (RAP) to the Scholastic Reading 180 reading course for students in grades 9 and 10 receiving supplemental reading
  • Students who had the addition of K-D RAP to their existing reading intervention saw nearly twice the improvement in reading fluency compared with reading intervention alone.
  • The greatest improvement occurred in the placebo group after crossing over to K-D RAP
Parkinsonism & Related Disorders. 2014; 20(2):226-9.

Slowing of Number Naming Speed by King-Devick Test in Parkinson’s Disease

Authors: Lin TP, Adler, CH, Hentz JG, Balcer LJ, Galetta SL, Devick S
Publication: Parkinsonism & Related Disorders. 2014; 20(2):226-9.
Date: February 2014
Tags:

BACKGROUND: The King-Devick (KD) test measures the speed of rapid number naming, and is postulated to require fast eye movements, attention, language, and possibly other aspects of cognitive functions. While used in multiple sports concussion studies, it has not been applied to the field of movement disorders.

METHODS: Forty-five Parkinson’s disease (PD), 23 essential tremor (ET), and 65 control subjects were studied. Subjects performed two trials of reading out loud single-digit numbers separated by varying spacing on three test cards that were of different formats. The sum time of the faster trial was designated the KD score and compared across the three groups.

RESULTS: PD patients had higher (worse) KD scores, with longer reading times compared to ET and control subjects (66 seconds vs. 49 sec. vs. 52 sec., p < 0.001, adjusting for age and gender). No significant difference was found between ET and control (Δ = -3 seconds, 95% CI: -10 to 4).

CONCLUSIONS: This is the first study of the King-Devick Test in Parkinson’s disease. PD patients were found to have a slower rapid number naming speed compared to controls. This test may be a simple and rapid bedside tool for quantifying correlates of visual and cognitive function in Parkinson’s disease.

Summary Points:

  • Two trials of the K-D Test were administered to individuals with Parkinson’s Disease (PD) and essential tremor (ET) and compared with controls.
  • Those with PD scored significantly worse on the K-D Test compared to those with ET and the control group (adjusting for age and gender).
  • There was no significant difference in scores in the ET group verses control group.
  • The K-D Test may be an effective bedside tool for quantifying aspects of visual and cognitive function in patients with PD.
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Presented at the American Optometric Association 2012 Annual Meeting

The King-Devick Test as a Reading Fluency Training Program For Students in Elementary Schools

Authors: Allen M, Beatty R, Blanco S, Devick S, Kattouf V, Messner L, Messner S, Pang Y, Tennant A, Richardson LD
Publication: Presented at the American Optometric Association 2012 Annual Meeting
Date: April 2012
Tags:

The King-Devick Test is an established eye movement test that has been used historically to detect reading disorders related to poor visual-motor skills. Seventeen students in grades 2-4 from the St. Elizabeth School in Chicago Illinois, a predominantly African American K-8 school, were screened for reading inefficiency using the King-Devick Test (K-D Test) and assessed in reading fluency using the Scholastic Fluency Test pre- and post-treatment. The control group had a mean-word improvement of 13.11 words as compared to a 30.02 mean word improvement in the treatment group (p = 0.0413). A Sub-group analysis of grades 2 and 3 showed a mean word improvement of 31.94 among the treatment group as compared to 13.11 for the placebo group (p = 0.0267). Reading fluency measures significantly improved following eye movement training.

Summary Points:

  • Reading fluency significantly improved following 6 weeks of the King-Devick Reading Acceleration Program for 2nd and 3rd grade
  • Fourth grade student reading performance improved somewhat, however the improvement was not as drastic as seen for 2nd and 3rd grade students, indicating there is likely an optimal time frame to implement the eye movement training.
  • Eye movement training programs should be considered as a part of reading curricula in