Professional Documents
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Nelson 2017
Nelson 2017
Nelson 2017
*Correspondence to: Jason M. Nelson, Regents’ Center for Learning Disorders, University of Georgia, 337
Milledge Hall, Athens, GA 30602, USA. E-mail jmnelson@uga.edu
dyslexia, will likely continue to grow and that these individuals may access disability
and other services at an increasing rate.
Along with a rising rate of learning disabilities on college campuses, anxiety and
depression have also increased drastically. College counselling directors have re-
ported a significant increase in anxiety and depressive disorders over the past
5 years (Gallagher, 2014). In a recent national survey of college students, nearly
60% reported experiencing overwhelming anxiety and approximately 35% re-
ported feeling so depressed that it was difficult to function at some point within
the year prior to being surveyed (American College Health Association, 2015).
Anxiety and depression are now the two most common referral concerns by col-
lege students seeking counselling services (Reetz, Barr, & Krylowicz, 2014).
College students with dyslexia may be at particular risk for elevated depressive
and anxiety-related symptoms. From the lens of a demoralization hypothesis
(e.g. see Biederman, Mick, & Faraone, 1998), it seems logical that students with
dyslexia may experience significant discouragement as a result of their learning
difficulties, which may result in heightened depressive and anxiety-related symp-
tomatology secondary to these difficulties. These students, relative to their class-
mates without disabilities, have been shown to experience an abundance of
academic-related issues beyond their reading problems, including poorer test-
taking skills (Holzer, Madaus, Bray, & Kehle, 2009), study skills (Kirby, Silvestri,
Allingham, Parrila, & La Fave, 2008), and note-taking skills (Hughes & Suritsky,
1994). Academic-related problems are the most commonly cited attribution for
heightened internalizing symptomatology among college students (Furr, Westefeld,
McConnell, & Jenkins, 2001).
Although the demoralization hypothesis seems intuitive when applied to college
students with dyslexia, some findings suggest that adulthood may be a time of im-
proved emotional functioning for individuals with dyslexia. Bruck (1987) found
that children with learning disabilities longitudinally followed to adulthood demon-
strated improved socioemotional adjustment. Increased opportunity for niche
picking in young adulthood is one mechanism by which the socioemotional func-
tioning of individuals with dyslexia may improve (McNulty, 2003). Relative to com-
pulsory education, the college environment offers students more opportunities to
select courses of interest along with a much broader range of instructors teaching
these courses. Furthermore, the postsecondary environment offers more oppor-
tunities for niche picking in nonacademic domains such as extracurricular activities
and peer groups. Some research indicates that college students with dyslexia per-
ceive the postsecondary environment to be a more sympathetic one than the en-
vironment experienced during their compulsory education (Riddick, Sterling,
Farmer, & Morgan, 1999).
Given these opposing viewpoints on the potential risk for increased depressive
and anxiety-related symptomatology of college students with dyslexia, there is not
an obvious answer to the question of whether this group is at particular risk, de-
spite anecdotal reports suggesting that it is essentially inevitable that individuals
with dyslexia experience significant emotional problems (e.g. Edwards, 1993). Sur-
prisingly little research has been conducted on depression and anxiety among col-
lege students with learning disabilities in general and college students with dyslexia
in particular. After conducting a meta-analysis of the empirical literature on inter-
nalizing problems among adults with learning disabilities, Klassen, Tze, and Hannok
(2011) declared a ‘clarion call for further research in this area’ (p. 324). They
located only eight published studies that used adult learning disabled samples.
Results indicated small overall effect sizes for increased depressive and anxiety-
related symptoms among adults with learning disabilities, but the findings among
the included studies were highly heterogeneous, with effect sizes ranging from
0.08 to 1.71. Generalizing these results to college students with dyslexia is prob-
lematic because of the significant heterogeneity within the broad learning disability
category (Burden, 2008; Carroll & Iles, 2006; Riddick et al., 1999).
Minimal research has examined depressive and/or anxiety-related symptoms
specifically within adult dyslexic samples. Results have been mixed with some
studies showing elevated symptoms relative to control groups without dyslexia
(Carroll & Iles, 2006; Wilson, Armstrong, Furrie, & Walcot, 2009), some showing
equivalent symptoms between these groups (Boetsch, Green, & Pennington, 1996;
Nelson & Gregg, 2010; Riddick et al., 1999; Tops, Verguts, Callens, & Brysbaert,
2013), and still others showing varied results depending on the instruments used
to measure these symptoms (Ghisi, Bottesi, Re, Cerea, & Mammarella, 2016;
Jordan, McGladdery, & Dyer, 2014). Additionally, most of these studies have signif-
icant limitations, including small sample sizes, participants with self-identified dys-
lexia, and participants who were identified as dyslexic only by way of being
formally recognized as such through a postsecondary disability services office.
Mixed results from a small number of empirical studies with significant methodo-
logical limitations indicate the need for further research on this topic.
A topic that has been minimally investigated in conjunction with the investiga-
tion of depressive and anxiety-related symptomatology is the possibility that col-
lege students with dyslexia may engage in elevated socially desirable responding
(SDR). Although there are many complex descriptions of SDR (see Paulhus,
2002 for a review), it generally involves providing overly positive self-descriptions
(e.g. ‘I am always kind to everyone’) and denying imperfections characteristic of
everyone (e.g. ‘I never get angry’). When assessing the possibility of heightened de-
pressive and anxiety-related symptomatology, the individual’s self-report is heavily
relied upon because many of these symptoms are internal in nature and therefore
are not readily observable by others. Individuals who endorse high desirability
items on self-report measures and disavow low desirability items may be providing
responses contingent upon item desirability rather than each item’s accuracy in
describing their emotions and behaviours (Paulhus, 2002). Therefore, determining
the presence of depressive and anxiety-related symptoms among those who en-
gage in high SDR is difficult because the accuracy of their responses is in question.
Some indirect empirical evidence suggests that individuals with dyslexia may
engage in elevated SDR. Most of this evidence is derived from the broad learning
disability research literature, suggesting that individuals with learning disabilities
demonstrate a tendency to assess their skills, abilities, and other characteristics
more favourably than others assess them or than is justified based on objective
indicators. Individuals with learning disabilities have been found to rate their cog-
nitive, language, and academic skills more highly than teachers and parents rate
them (Meltzer, Roditi, Houser, & Perlman, 1998; Stone, 1997), to overestimate
their social acceptance by peers (Nowicki, 2003) and to favourably miscalibrate
their perceptions of academic and nonacademic skills relative to their actual
demonstration of these skills (Job & Klassen, 2012). Collectively, these findings
indicate that individuals with learning disabilities may demonstrate overly positive
self-perceptions, which may result in possible susceptibility to overly endorsing
METHOD
Participants
Participants with dyslexia
The dyslexia group consisted of 110 participants. In order to be included in the
dyslexia group, participants were required to meet the following criteria. First,
participants were required to meet the University System of Georgia criteria for
learning disabilities (see http://www.usg.edu/academic_affairs_handbook/ for fur-
ther information) and were determined to be eligible as individuals with disabilities
under the Americans with Disabilities Act. Briefly, these criteria were based on a
psychological processing model of defining learning disabilities, which required
academic impairment and identification of a psychological processing deficit that
was meaningfully associated with the area of academic impairment. Consistent
with the International Dyslexia Association definition of dyslexia (Lyon, Shaywitz,
& Shaywitz, 2003), all participants experienced impairment in accurate or fluent
word-level reading or spelling. Impairment was operationalized as at least two
scores ≤85 on norm-referenced measures of reading and spelling. This cut-off is
1 SD below the mean and has been recommended as an adequate severity level
for identifying impairment (Dombrowski, Kamphaus, & Reynolds, 2004). Docu-
mentation of impairment on at least two measures has been proposed as a method
for ensuring the validity of learning disabilities diagnoses (Brueggermann,
Kamphaus, & Dombrowski, 2008). To ensure that the participants met the Inter-
national Dyslexia Association definition of dyslexia, all participants were required
to have at least one score ≤85 on a norm-referenced measure of word-level
reading accuracy, word-level reading fluency, or spelling. The second score ≤85
was permitted to be on a measure of connected text reading fluency or timed
reading comprehension. Second, the participants were required to have been
attending a 4-year university. This criterion was imposed because participants
without dyslexia were all undergraduates attending a 4-year university, and we
attempted to match the groups as closely as possible. Third, participants with dys-
lexia were required to be between the ages of 18 and 25 years. This age range is
consistent with the normative age range of the self-report instrument used to
measure the dependent variables.
Diagnoses were made by licensed psychologists after completing a comprehen-
sive evaluation at a university-based clinic. The evaluations included a clinical inter-
view; review of the participant’s history (including developmental, medical,
academic, and social background); and assessment of general cognitive functioning,
specific cognitive/linguistic processing abilities (e.g. phonological processing), and
academic skills. Evaluations included approximately 8 to 10 h of assessment over
the course of 2 days and were tailored to the referral question of each participant.
While the general approach in which the evaluations were conducted was similar
across the licensed psychologists, the specific measures used to assess for dyslexia
varied, and therefore, not all participants were identified by using exactly the same
measures. Descriptive information regarding IQ and reading skills of the dyslexic
group can be found in Table 1. Furthermore, of the 110 participants with dyslexia,
80 (72.7%) reported being diagnosed prior to the evaluations used in the current
study.
Table 1. Descriptive statistics regarding IQ and reading skills of participants with dyslexia
M SD
a
IQ 101.14 11.56
Basic reading skillsb 82.69 11.00
Word reading 86.33 9.90
Pseudoword decoding 82.25 11.43
Word reading efficiencyc 75.67 9.37
Sight word reading efficiency 80.53 8.87
Pseudoword decoding efficiency 77.03 9.83
a
IQ includes 79 participants who were administered the Wechsler Adult Intelligence Scale Fourth Edition General Ability Index
and 31 participants who were administered the Reynolds Intellectual Assessment Scales Composite Intelligence Index.
b
Basic reading skills include 2 participants who were administered the Woodcock-Johnson III Diagnostic Reading Battery, 95 par-
ticipants who were administered the Woodcock-Johnson III Tests of Achievement, and 13 participants who were administered
the Woodcock-Johnson IV Tests of Achievement.
c
Word reading efficiency includes 40 participants who were administered the Test of Word Reading Efficiency and 52 participants
who were administered the Test of Word Reading Efficiency Second Edition.
Instruments
Depression and anxiety
The depression and anxiety scales of the Behavior Assessment System for
Children, Second Edition—Self-Report of Personality—College version
(BASC-2-SRP-COL; Reynolds & Kamphaus, 2004a) were used to measure de-
pressive and anxiety-related symptomatology. Scores on the scales are re-
ported as T-scores with M of 50 and SD of 10. The depression and anxiety
scales consist of 13 and 14 items, respectively. Items required a mixture of
true/false and four-point rating scale (never to almost always) responses to
statements about the individual’s experience of a variety of depressive and
anxiety-related symptoms (e.g. sadness, anhedonia, nervousness and inability
to relax). Reynolds and Kamphaus (2004b) reported internal consistency reli-
ability coefficients of 0.89 for the anxiety scale and 0.88 for the depression
scale. The SRP-COL also demonstrated adequate convergent validity with con-
ceptually similar scales of the Achenbach System of Empirically Based Assess-
ment Child Behavior Checklist (anxiety = 0.56; depression = 0.38), Brief
Symptom Inventory (anxiety = 0.50; depression = 0.50), Beck Depression In-
ventory (depression = 0.60), and Minnesota Multiphasic Personality Inventory
—Second Edition (depression = 0.56).
Social desirability
Embedded within the BASC-2-SRP-COL is the L-index, which is designed to detect
a response set that suggests that the examinees may be ‘faking good’ or portraying
themselves in a socially desirable manner. Thus, elevation of the L-index indicates
that the respondent may desire to present an idealized view of the self by denying
slightly undesirable acts or behaviours in which most people engage. The index
consists of 13 items that include statements like, the respondent is friends with ev-
eryone he/she meets, they never tell even a small lie, or that they do not feel emo-
tions such as jealousy or anger. Raw scores ≥7 indicate that the respondent is in
the caution range (Reynolds & Kamphaus, 2004b).
Reading
To examine the relationships of depressive symptoms, anxiety-related symptoms,
and SDR with the reading skills of participants with dyslexia, we used the Nelson-
Denny Reading Test (NDRT; Brown, Fishco, & Hannah, 1993a) comprehension
test. On this test, the participants were asked to read passages and answer multi-
ple choice questions about the passages within a 20-min time limit. The NDRT
comprehension test was chosen partially out of convenience; all participants with
dyslexia were administered this test, and therefore, these scores were stored in
the archival database used to conduct the study. More importantly, however,
the NDRT comprehension test is purported to measure fluent comprehension,
which has been referred to as the ‘sine qua non of reading’ (Norton & Wolf,
2012, p. 446). It is not a test of pure reading comprehension, per se, but a test
of how efficiently examinees can read connected text and demonstrate compre-
hension. Because the postsecondary environment frequently requires extensive
reading, fluent comprehension is needed in order to keep up with reading
demands. We therefore included a measure of fluent comprehension because it
is more likely associated with real-world reading demands than are more basic
reading measures. The NDRT comprehension test has demonstrated adequate
reliability, with Kuder–Richardson 20 coefficients ranging from 0.85 to 0.94
(Brown, Fishco, & Hannah, 1993b).
Procedures
Internal Review Board approval was obtained prior to conducting the current
study, and all participants provided written informed consent. Data gathered from
the dyslexia sample were archival and obtained from the previously mentioned
comprehensive evaluations. All individuals with records in the archival database
were included if they met the previously mentioned criteria. Evaluations of the
participants without dyslexia were conducted by a psychology doctoral student
and completed in group settings.
RESULTS
Group membership and gender were included as independent variables in the fol-
lowing analyses of variance (ANOVAs). No gender-group interactions were
found. Gender had a significant main effect when anxiety was the dependent vari-
able. Further analysis of gender is presented in a separate section in the succeeding
texts.
As shown in Table 2, differences between groups on depressive and anxiety-
related symptoms were not statistically significant. Participants with dyslexia had
significantly higher SDR scores than did those without dyslexia, and the effect size
for this difference was medium. Chi-square analysis showed that participants with
dyslexia were significantly more likely to be in the caution range on the L-index than
were controls, χ 2(1, N = 220) = 22.45, p < 0.001. Indeed, of the 110 participants
in the dyslexia group, 31 were in the caution range compared with 5 of the partic-
ipants without dyslexia.
We also compared the groups with and without dyslexia on depressive and
anxiety-related symptoms while controlling for SDR. Results from these analyses
of covariance are shown in Table 2 and indicate that even with SDR controlled,
there was no significant difference in anxiety-related symptoms between the
groups. In contrast, with SDR controlled, depressive symptoms of the dyslexia
group were significantly higher than those of participants without dyslexia. The ef-
fect size for this difference was small.
No dyslexia Dyslexia
M (SD) M (SD) F p d
Analysis of variance results
Anxiety 50.37 (12.15) 50.16 (11.52) 0.02 0.90 0.02
Depression 46.48 (5.56) 48.37 (10.45) 2.81 0.10 0.23
Social desirability 2.68 (2.09) 4.50 (3.08) 26.26 <0.001 0.69
Analysis of covariance
results with Behaviour
Assessment System
for Children (BASC)
L-index as a covariate
Anxiety 49.62 (12.02) 50.91 (12.02) 0.60 0.44 0.11
Depression 45.87 (8.44) 48.98 (8.44) 7.07 <0.01 0.37
*
Note. Estimated SD for ANCOVAs = (SE √n) for each group.
*p < 0.05.
**p < 0.01.
Gender Analyses
DISCUSSION
In our view, the group difference on the SDR variable is the most significant finding
of the current study. College students with dyslexia were clearly more likely than
those without dyslexia to engage in SDR. When we considered the participants’
BASC-2 L-index scores in relation to the established cut-off for determining a
concerning level of SDR, the magnitude of these group differences was particularly
elucidated. Nearly 30% of college students with dyslexia had L-index scores in the
caution range compared with less than 5% of college students without dyslexia.
The L-index is a validity measure designed to detect a self-report response style
that is driven by the social desirability of item content rather than an accurate por-
trayal of actual symptomatology. This type of response style is thought to contam-
inate the assessment process, leaving the clinician with questionable self-report
data upon which to determine the possible presence of psychopathology. Our re-
sults indicate that, relative to college students without dyslexia, approximately six
times as many college students with dyslexia produced self-reports of questionable
validity due to elevated SDR. The standard interpretation of elevated SDR is that it
higher within the dyslexic group compared with the group without dyslexia, al-
though the magnitude of this difference was small and the resulting adjusted mean
score on the scale used to measure depression was well within the average range
for the dyslexic group. Even with SDR controlled, group differences in anxiety-
related symptoms were not found. Further evidence for the role of SDR in under-
standing depressive and anxiety-related symptoms among the dyslexic group was
derived from the correlational analyses, which indicated negative associations be-
tween SDR and these symptoms for the dyslexic group but not for the group with-
out dyslexia. Of course, these results are only correlational and therefore prevent
the causal inference that SDR caused an under-reporting of depressive and
anxiety-related symptoms, but there does appear to be meaningful relationship
of these symptoms with SDR.
Although group differences in SDR were sizeable, the current results indicating
no group differences in anxiety-related symptoms even with SDR controlled,
modest differences in depressive symptoms with SDR controlled and only modest
correlations of SDR with depressive and anxiety-related symptoms suggest that
this topic is more complicated than can be explained by only suppressor effects
associated with SDR. In fact, although test developers who create SDR scales do
so to measure the validity of self-report responses and characterize SDR as a
source of contamination in the assessment process, this perspective is only par-
tially consistent with empirical research on SDR. After reviewing the SDR litera-
ture, Holden and Passey (2009) stated, ‘Presently, discerning whether social
desirability is part of the construct being measured or an interfering response style
is not an easy task and is not well established either theoretically or empirically’
(p. 443) and concluded that ‘researchers are far from reaching a consensus on
the contamination-versus-legitimate content issue’ (p. 444). As is alluded to in
these statements, some empirical research suggests that it is simplistic to concep-
tualize SDR as only a contaminant variable and that, in fact, there appears to be
some degree of truth to this type of responding. These findings have led some re-
searchers to argue for the need to demonstrate ‘departure-from-reality’ (Paulhus,
2002, p. 49) as a criterion when characterizing SDR as a contaminant variable.
Departure-from-reality was not established in the current study, and therefore,
our results may at least partially suggest that college students with dyslexia are
more likely to truly possess some of the characteristics indexed on SDR measures.
Furthermore, higher rates of these characteristics may play a role in warding off
depressive and anxiety-related symptomatology.
Finally, nonsignificant or modest differences in depressive and anxiety-related
symptoms between the groups with and without dyslexia may at least partially
be a reflection of the former group’s resilience. The dyslexic group’s achievement
of entrance into 4-year colleges suggests that they may possess a higher level of
resilience than is demonstrated by the average individual with learning disabilities,
as most high school students with learning disabilities do not pursue 4-year post-
secondary education (Newman et al., 2011). Some extant research suggests that
college students with learning disabilities possess at least equivalent levels of resil-
ience relative to their peers without learning disabilities (Ghisi et al., 2016),
whereas other research indicates that they may possess higher levels of resilience
(Hall, Spruill, & Webster, 2002). Therefore, the dyslexic group’s resilience may
have aided in preventing the development of significant depressive and anxiety-
related symptoms despite possessing risk factors associated with these symptoms.
Limitations
The findings of the present study are limited to the sample and methods described.
First, the specificity of the sample (e.g. individuals with dyslexia who were attend-
ing a 4-year university) is not typical of the broader adult dyslexic population. As
previously mentioned, most individuals with learning disabilities do not attend
4-year postsecondary institutions and, when they do, most do not seek academic
accommodations (Newman et al., 2011), as was the case with the current sample.
Therefore, these results should not be generalized to the broader adult population
with dyslexia. Furthermore, the ethnically and geographically homogenous nature
of the sample prevents broad generalizability. Second, the measures used in the
current study are most accurately characterized as screeners. Thus, the
constructs were not measured as thoroughly as is possible when using tools spe-
cifically designed to measure these constructs; a more thorough investigation of
these constructs may have produced different results. The SDR measure was uni-
dimensional and therefore narrow in its conceptualization. SDR is likely more ac-
curately conceptualized as a multidimensional construct (Perinelli & Gremigni,
2016), and measuring its different components may have led to a more thorough
understanding of its influence on college students with dyslexia. Third, we cannot
guarantee that all participants in the group without dyslexia did not have dyslexia.
Participants in this group only self-reported never being diagnosed with any type of
learning disorder; formal evaluation would have better ensured that there were no
participants with dyslexia in this group. Additionally, because these participants
were not administered the NDRT, it is unknown whether the negative correlation
between NDRT and BASC L-index scores is unique to the group with dyslexia.
Fourth, although participants with dyslexia were diagnosed by licensed psycholo-
gists after a comprehensive evaluation, evaluation procedures varied based on
the referral concern and specific assessment measures varied based on the prefer-
ences of individual psychologists. Using a more consistent approach to evaluation
likely would reduce concerns regarding diagnostic veracity and would have per-
mitted the investigation of relationships between SDR and other aspects of reading
in addition to fluent comprehension.
Implications
Our results clearly indicate that college students with dyslexia engaged in signif-
icantly higher SDR than did those without dyslexia, raising some questions about
the validity of their self-reports and indicating the need to evaluate these reports
beyond their face value. Therefore, we recommend including a measure of SDR
when evaluating internalizing symptomatology among college students with dys-
lexia. We also recommend inclusion of not only self-report ratings but also ob-
server ratings when determining the possibility of anxiety and depression among
college students with dyslexia. Although internalizing symptomatology is gener-
ally less observable than is externalizing symptomatology, the former consists
of some features that may be observed by others (e.g. lethargy and flat affect).
Because cross-informant agreement will likely be modest, at best, for most cases
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