Psychiatry Research 324 (2023) 115188

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Associations between dyslexia and children’s mental health: Findings from

a follow-up study in China
Pei Xiao a, Kaiheng Zhu a, Yanan Feng a, Qi Jiang a, Zhen Xiang a, Quan Zhang a, Xufang Wu a,
Yixi Fan a, Li Zou b, Han Xiao c, **, Ranran Song a, *
a
Department of Maternal and Child Health and MOE Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science
and Technology, Wuhan, China
b
Department of Child Healthcare, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
c
Institute of Maternal and Child Health, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

A R T I C L E I N F O A B S T R A C T

Keywords: Dyslexia is a common learning difficulty that can lead to adverse health outcomes and socioeconomic difficulties.
Dyslexia Evidence from longitudinal studies on the association between dyslexia and psychological symptoms in children
Anxiety symptoms is limited. Moreover, the psychological trends of children with dyslexia are unclear. In this study, we enrolled
Depression symptoms
2,056 students in Grades 2 to 5, including 61 dyslexic children, who participated in three mental health surveys
Stress symptoms
A follow-up study
and dyslexia screening. All the children were surveyed for symptoms of stress, anxiety and depression. We used
China generalized estimating equation models to estimate changes in psychological symptoms of children with dyslexia
over time and the association between dyslexia and psychological symptoms. The results showed that dyslexia
was associated with stress and depressive symptoms in children in both crude (β = 3.27, 95% confidence interval
[CI] [1.89~4.65], β=1.20, 95%CI: [0.45~1.94], respectively) and adjusted models (β = 3.32, 95%CI:
[1.87~4.77], β=1.31, 95%CI: [0.52~2.10], respectively). In addition, we found no significant differences in the
emotional status of dyslexic children in either survey. Dyslexic children are at risk for mental health issues, and
persistent emotional symptoms. Therefore, interventions regarding not only reading ability but also psycho­
logical conditions should be pursued.

1. Introduction
Reading acquisition, an essential challenge in children’s develop­
mental trajectory, is a key determinant of educational success during
primary school (Costa et al., 2013). Dyslexia is a common learning
disorder (Sigurdardottir et al., 2017) that affects approximately 5%
to17.5% of school-age children in English-speaking populations and 3%
to12.6% of school-age children in China (Xue et al., 2020). Children
with dyslexia have problems in word recognition, spelling, and decod­
ing, despite typical intelligence and no evident neurological or sensory
deficits (Gialluisi et al., 2019; Gu et al., 2018). The process of learning to
read is fraught with struggle and frustration for them, and this unex­
plained and unsupported failure has a negative impact on them later in
life (Firth et al., 2013).
Research has reported that almost 60% of dyslexic children meet the
criteria for at least one mental disorder (Margari et al., 2013). High
proportions of anxiety and depression problems among dyslexic children
have been demonstrated in many studies (Francis et al., 2019; Gabriely
et al., 2020; Hendren et al., 2018). Willcutt and Pennington’s (Willcutt
and Pennington, 2000) community study of twins indicated that people
with reading disabilities exhibit significantly higher rates of internali­
zation and externalization disorders than people without reading dis­
abilities. Research conducted by Wang in Taiwan, China (Wang, 2021),
showed that children with dyslexia have higher levels of anxiety and
depression symptoms. For students, lower academic attainment predicts
increased anxiety and depressive symptoms(Kessler et al., 1995).
Studies have identified that school-related stress and anxiety are more
prevalent in middle school students with dyslexia (Geisthardt and

* Corresponding author at: Department of Maternal and Child Health and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical
College, Huazhong University of Science and Technology, No 13 Hangkong Road, Wuhan, Hubei, China.
** Corresponding author at: Institute of Maternal and Child Health, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China.
E-mail addresses: tjxiaohan1980@163.com (H. Xiao), songranran@hust.edu.cn (R. Song).

https://doi.org/10.1016/j.psychres.2023.115188
Received 13 May 2022; Received in revised form 27 March 2023; Accepted 31 March 2023
Available online 6 April 2023
0165-1781/© 2023 Elsevier B.V. All rights reserved.
P. Xiao et al.
Munsch, 1996; Wenz-Gross and Siperstein, 1998). Researchers also say
that because dyslexic children perceive themselves to be less competi­
tive than typically developing children they are more likely to regard
themselves as abnormal. It is this low self-worth that makes them feel
nervous (Alexander-Passe, 2008). In addition, low self-esteem may be a
cause of depression in children with dyslexia (Hendren et al., 2018). The
higher incidence of bullying and peer victimization of these children
may partly explain the comorbidity of dyslexia and depression as well
(Baumeister et al., 2008; Mishna, 2003). However, the results in the
literature are inconsistent. Miller et al. suggest that dyslexia is not
related to elevated levels of internalizing symptoms (Miller et al., 2005).
A previous study of us indicated that dyslexia positively correlated with
depressive and stress symptoms, but its association with anxiety symp­
toms was not significant (Xiao et al., 2022).
These differences can probably be attributed to methodological in­
consistencies across studies. One important observation is that surveys
of mental health status reflect psychological conditions only over a
certain period of time. To the best of our knowledge, most of the above
findings are based on group comparisons made at one point in time or
from a cross-sectional studies, longitudinal studies are needed to further
examine this association.
Furthermore, evidence for the emotional well-being of persons with
learning disabilities or dyslexia suggests that poor mental health con­
ditions may persist but may differ slightly at different times (Klassen
et al., 2013). Other researchers, however, have discovered that the
emotional symptoms of people with learning disabilities increase with
age (Wilson et al., 2009). Some studies have also shown that the mental
health problems of dyslexic children decrease over time (Carroll and
Iles, 2006). These studies were carried out in the west and focused on
adolescents and adults; few studies have explored the psychological
trends among Chinese children with dyslexia.
Because the correlation between dyslexia and psychological prob­
lems in children is unclear, and there is a lack of research on the
developmental trends of mental symptoms in children with dyslexia in
China, in this study we aimed to examine the association between
dyslexia and children’s mental health in China by using longitudinal
data. We also observed trend in psychological symptoms in children
with dyslexia.
2. Materials and methods
2.1. Study population
The current study enrolled students from Grades 2 through 6 in two
primary schools in Wuhan, Hubei province. We have been screening for
dyslexia in Grades 2 through 6 in these schools since 2019. To date, a
total of 3534 pupils at the two schools have been screened for dyslexia,
127 of whom were identified with dyslexia. We conducted the psycho­
logical surveys in December 2020 (Wave 1), June 2021 (Wave 2), and
December 2021 (Wave 3). A total of 4071 children completed the survey
at Wave 1, 3479 children tool part in Wave 2 and 4284 took part in Wave
3. Using the child’s name, gender, school, grade level, and class, we
matched data from three psychological surveys with data on dyslexia.
Because previous sixth graders had already moved on to secondary
school, and some students had taken only one or two mental health
surveys, only 2056 students took both the psychological survey and the
dyslexia screening; 61 of these children had dyslexia. Therefore, the
actual study population included in this study comprised students in
grades 2to 5 at Wave 1. The Ethics and Human Subject Committee of
Tongji Medical College, Huazhong University of Science and Technology
approved this study. Each student (as well as the parent/guardian) gave
oral/written informed consent.
2
Psychiatry Research 324 (2023) 115188
2.2. Measures
2.2.1. Dyslexia screening
The Dyslexia Checklist for Chinese Children (DCCC) and Pupil Rating
Scale-Revised Screening for Learning Disabilities (PRS) were used to
filter the dyslexic children. The DCCC scale is based on the International
Classification of Disease, 10th Revision (ICD-10), the Diagnostic and Sta­
tistical Manual of Mental Disorder, 4th Edition (DSM-IV), and clinical
symptoms of dyslexia as well (Liu et al., 2022). The DCCC was originally
used to evaluate the reading ability of children in Grades 3 to 6, and in
2018 it was verified to have good reliability and validity in screening for
dyslexia in Grades 2 (Xie et al., 2021). It contains 57 items, 55 of which
loaded onto eight factors. The items are rated in a Likert-type format
with 5 options (1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 =
always). The scale shows adequate validity (correlation coefficients
range from 0.218 to 0.372) and reliability (test-retest reliability is 0.734
and the internal consistency of all subscales is above 0.752) (Hou et al.,
2018). The PRS is a 24-item, 5-point scale that is a well-regarded tool for
screening learning disabilities in China. It has good validity (criterion
validity correlation coefficients range from 0.53 to 0.63) and reliability
(test-retest correlation coefficients > 0.80) (Jin et al., 1998; Liu et al.,
2020) as well.
The DCCC was completed by the children’s parents or guardians, and
the PRS was completed by the head teacher according to the child’s daily
performance in school. A higher DCCC score implies poor reading
ability. The higher the PRS score, the superior the learning ability (Xue
et al., 2020). A child who meets all the following criteria: (1) DCCC score
is 2 standard deviations higher than the median score in the same grade;
(2) PRS score reported by the teacher is < 65; (3) a Chinese language test
score in the bottom 10% of class. In addition, children who have a his­
tory of diagnoses like intellectual disability, brain injury, epilepsy, and
visual and auditory impairment were excluded. The above information
was obtained from their medical history at their schools and from their
parents. These standards have been developed and widely used in
studies of the prevalence of and risk factors for dyslexia in mainland
China (Gu et al., 2018; Kong et al., 2016; Shao et al., 2016; Sun et al.,
2013).
2.2.2. Children’s stress
The Chinese Perceived Stress Scale (CPSS) was used to assess the
degree to which life conditions were perceived as stressful in the past
month. The scale was introduced and revised by Yang and is extensively
used in China (Feng et al., 2019; Yang and Huang, 2003). The 14 items
of the CPSS are rated on a 5-point Likert scale, that ranges from 1 (never)
to 5 (always) (Wang et al., 2021). Possible total scores range from 0 to
56, with higher scores indicating a greater level of stress (Ge et al.,
2020). A previous study showed that the Cronbach’s α coefficient of
CPSS is 0.78 (Yang and Huang, 2003).
2.2.3. Children’s anxiety symptoms
The Screen for Child Anxiety-Related Emotional Disorder (SCARED)
was chosen to evaluate the anxiety symptoms at Wave 1 and Wave 2. It is
a 41-items self-report questionnaire (Srinath et al., 2014a) that is
divided into five subscales (Panic/Somatic, Generalized Anxiety, Sepa­
ration Anxiety, Social Phobia, and School Phobia) (Abend et al., 2018).
Ratings are made on a Likert scale on which 0= none, 1 = sometimes, and
2 = frequently (Xiao et al., 2022). Total scores range from 0 to 82, with
higher scores indicating more severe anxiety symptoms (Srinath et al.,
2014b). The SCARED demonstrates strong internal consistency for the
whole scale (Cronbach’s α=0.95) and each subscale (Cronbach’s α=0.72
to 0.88) (Shum et al., 2019).
2.2.4. Children’s depressive symptoms
The severity of depression was measured through the Children’s
Depression Inventory-Short Form (CDI-S). For each item, participants
were asked to choose one of three answers that best describe how they
P. Xiao et al. Psychiatry Research 324 (2023) 115188

had felt over the past 2 weeks. The CDI-S, consisting of 10 items, each for 25.0% (n = 513), and those with an annual income of >¥100,000
scored with 0, 1, or 2 points. Depression is rated on a scale of 0 to 15; accounted for 71.5% (n = 1471). Additionally, 61 (3.0%) of the children
higher scores indicate more serious symptoms of depression (de la Vega had been screened with dyslexia.
et al., 2016). Because of its good reliability (mean Cronbach’s α=0.84)
and validity (Li et al., 2019), this scale has been widely used in ado­ 3.2. Baseline follow-up of the psychological status of dyslexic children
lescents ages 7 to 18 (de la Vega et al., 2016; Sutherland et al., 2020).
The scale is validated for use in Chinese (Guo et al., 2015; Xie et al., At Wave 1, dyslexic children had median stress, anxiety, and
2020). depression levels of 28.00, 16.00, and 4.00, respectively. At the second
wave, stress, anxiety, and depression median scores were 27.00, 14.50,
2.3. Statistical analyses and 3.00 respectively. At the third wave, the median levels of stress,
anxiety, and depression among dyslexic children were 26.00, 14.50 and
The SPSS 26.0 software was used for data analysis. Categorical var­ 3.00, respectively. The results show that psychological symptoms at
iables were presented in the form of using counts and percentages. Given Wave2 and Wave 3 were not significantly different from those at Wave 1
that the distribution of children’s psychological scores did not conform (all P>0.05). The details are presented in Table 2 and Table 3.
to a normal distribution, we used the median and interquartile range [M
(P25~P75)] for descriptions. 3.3. Associations between dyslexia and children’s psychological status
Generalized Estimating Equation (GEE) models were applied to es­ observed using the GEE models
timate changes in the psychological symptoms of children with dyslexia
over time and the association between dyslexia and psychological The results of the GEE models with different imputed factors (crude
symptoms. GEE models are suitable for longitudinal data analysis where and adjusted models) are described in Tables 4 and 5. In Table 4, we
missing data can exist (Ehrenstein et al., 2020; Saari et al., 2020). For the show the association between dyslexia and children’s mental health.
association between dyslexia and children’s mental health, 2 sets of The crude model suggests a positive association between dyslexia and
models were estimated: (1) a crude model, which contained only the stress and depressive symptoms. That is, the dyslexic children’s mean
dyslexic group; (2) a model adjusting for gender, grade, parent’s edu­ stress and depression scores were 3.27 (95% CI [1.89, 4.65]) and 1.20
cation level, and family economic status. The significance level was set (95% CI [0.45, 1.94]) higher than that of typically developing children.
at P<0.05, and 95% was set as the confidence interval (CI). Likewise, the adjusted model demonstrates that dyslexia had a positive
correlation with stress symptoms and depressive symptoms (β = 3.32,
3. Results and 1.33, respectively, all P < 0.01). However, the association between
dyslexia and children’s anxiety symptoms was not significant in either
3.1. Descriptive analysis the crude or adjusted models.
In Table 5, we present the associations between reading ability and
Basic demographic information of the participants is listed in children’s mental health. Both the crude model and the adjusted models
Table 1. Among 2056 children, 993 (48.3%) were girls. The proportion demonstrated that, the higher a child’s DCCC score was (i.e. the worse
of participants in Grades 2 to 5 were 27.0% (n = 555), 22.6% (n = 464), the reading ability), the more severe their symptoms of stress, anxiety,
27.0% (n = 555), and 23.4% (n = 482), respectively. As for father’s and depression were.
education, 740 (36.0%) reported a high school education or less, and
1272 (61.9%) reported more than high school, 44 (2.1%) did not pro­ 4. Discussion
vide relevant information. The maternal education of the participants
was as follows: 784 (38.1%) had a degree of high school or less, 1230 Combing data from 1-year time spans, in this study we found that
(59.8%) had a degree beyond high school, and 42 (2.0%) did not provide dyslexia has a negative impact on children’s mental health and that the
this information. Those with an annual income of <¥100,000 accounted emotional symptoms of dyslexic children persist over time.
The positive associations between dyslexia and stress and depressive
Table 1 symptoms in children are similar to those found in previous studies
The characteristic of the participants. (Martínez and Semrud-Clikeman, 2004; Wang, 2021). Except for some
evidence from observational studies, functional imaging and neuroan­
Characteristic n Percentage (%)
atomical studies of classical phonological dyslexia have found changes
Gender
in brain structure and function of the left hemisphere of the brain in
Male 1063 51.7
Female 993 48.3
dyslexic groups. Structural imaging studies have revealed
Grade under-activations of the distribution of the left hemisphere, such as in
2 555 27.0 the temporoparietal, and occipitotemporal regions (Hoeft et al., 2007;
3 464 22.6 Paulesu et al., 2014). There are indications that, in dyslexia, reduced
4 555 27.0
function of the language system in the left hemisphere is accompanied
5 482 23.4
Father’s education level by an increased function of the emotional systems in the right hemi­
High school or less 740 36.0 sphere, such as the anterior insula and thalamus (Ostertag et al., 2021;
Beyond high school 1272 61.9 Sturm et al., 2021). In addition, tighter connections between
Missing 44 2.1
Mother’s education level
High school or less 784 38.1 Table 2
Beyond high school 1230 59.8 Baseline follow-up of psychological status in dyslexic children.
Missing 42 2.0
Characteristic Wave 1 Wave 2 Wave 3
Family income
M (P25~P75) M (P25~P75) M (P25~P75)
<100,000 RMB/Year 513 25.0
≥100,000 RMB/Year 1471 71.5 Stress symptoms 28.00 27.00 26.00
Missing 72 3.5 (24.00~31.88) (22.31~31.12) (21.25~29.77)
Dyslexia group Anxiety 16.00 14.50 14.50
Yes 61 3.0 symptoms (10.00~27.75) (6.84~24.25) (8.00~22.50)
No 1995 97.0 Depressive 4.00 (2.00~6.92) 3.00 (2.00~6.50) 3.00 (1.75~6.25)
Total 2056 100 symptoms

3
P. Xiao et al. Psychiatry Research 324 (2023) 115188

Table 3 reasons for the increased level of anxiety symptoms in children with
Trends in psychological symptoms of dyslexic children over time. dyslexia. Some researchers believe that the elevated generalized anxiety
Follow-up β (95% CI) Waldχ 2 P- symptoms of children with learning disabilities were due to the fact that
time value those children often felt that things were out of control (Margalit and
Stress symptoms Wave1 ref Zak, 1984). Brain dysfunction theorists have proposed that learning
Wave2 − 1.25 1.50 0.221 disabilities and anxiety share a common brain-based etiology and
(− 3.24~0.75) therefore often occur together (Spreen, 1989).
Wave3 − 1.98 2.98 0.084 Although we used longitudinal data to confirm the association be­
(− 4.23~0.27)
Anxiety symptoms Wave 1 ref
tween dyslexia and child psychology, the inference of a causal rela­
Wave 2 − 2.94 3.78 0.052 tionship between the two is somewhat limited. Given the persistent
(− 5.91~0.02) psychological symptoms of dyslexic children, it is, necessary to imple­
Wave 3 − 3.22 3.68 0.055 ment interventions for these children, both in terms of reading ability
(− 6.51~0.07)
and mental health. Phonics-based reading instructions are the most
Depressive Wave 1 ref
symptoms common and efficient method for English-speaking poor readers
Wave 2 − 0.14 0.10 0.750 (McArthur et al., 2012), although Chinese interventions for dyslexia are
(− 0.97~0.70) not very mature and systematic at present. Current interventions for
Wave 3 − 0.30 0.42 0.518 Chinese reading skills include targeting working memory, and
(− 1.20~0.60)
magnocellular-based interventions (Luo et al., 2013; Qian and Bi, 2015).
Note: sex and grade have been adjusted in the model. In regard to the improvement of anxiety and depressive symptoms in
dyslexic children, cognitive-behavioral therapy (CBT) may be a choice.
emotion-related structures may contribute to symptoms of anxiety and This a therapy focuses on modifying negative behavior and thought
depression in people with dyslexia (Sturm et al., 2021). patterns (Hendren et al., 2018). According to several systematic reviews
A study of children with dyslexia found that they had enhanced and meta-analyses of CBT in children, most CBT of anxiety and
resting-state functional connectivity between the amygdala and the depression in children and adolescents present moderate to large effects
medial prefrontal cortex compared with children without dyslexia, and (Rith-Najarian et al., 2019).
greater connectivity between these structures is associated with higher We have to admit that there remain several limitations. First, the
anxiety symptoms (Davis et al., 2018). Research also has found, using an participants in our study were primary school students, and it is difficult
automated technique called voxel-based morphometry, that dyslexic to follow up with children who are about to enter junior school. Children
populations have a smaller gray matter volume compared with control in higher grades may experience more psychological problems
groups (Krafnick et al., 2011). The altered gray matter volume in the compared with children from the low and middle grades (Thienkrua
brains of dyslexic children may also partially explain why they have et al., 2006) and the transition from primary to secondary school is an
higher levels of anxiety and depressive symptoms (Zhang et al., 2019, important factor that can influence children’s internalized symptoms
2021). (Giovagnoli et al., 2020). In our study, sixth-graders were lost of
Although in this study the association between dyslexia and anxiety follow-up, which may have led, to some extent, to an underestimation of
was not significant, the results showed that the poorer a child’s reading the association between dyslexia and children’s mental health. Second,
ability was, the more severe the anxiety symptoms they experienced. there was a significant reduction in the number of dyslexic children
The positive association between DCCC scores and depressive and stress attending follow-up psychological visits, which we believe may be
symptoms was also confirmed. A meta-analysis indicated that approxi­ related to the characteristics of these children. To investigate the
mately 70% of children with learning disabilities had higher levels of changing trends of children’s psychological symptoms, long-term and
anxiety symptoms than their peers who did not have learning disabilities continuous follow-up is very necessary, especially for children with
(Nelson and Harwood, 2011). Several other studies have suggested dyslexia. Third, we investigated the psychological status of the children

Table 4
Results of GEE models showing the effect of dyslexia group on children’s psychological status by adjusting confounding factors.
Parameter Pressure symptoms coefficient (95% P value Anxiety symptoms coefficient (95% P value Depressive symptoms coefficient (95% P value
CI) CI) CI)

Crude model
Dyslexia group
No ref ref ref
Yes 3.27 (1.89~4.65) <0.001 0.74 (− 1.95~3.42) 0.590 1.20 (0.45~1.94) 0.002
Adjusted model
Dyslexia group
No ref ref ref
Yes 3.32 (1.87~4.77) <0.001 1.58 (− 1.30~4.45) 0.282 1.31 (0.52~2.10) 0.001

Note: The adjusted model adjusted for the survey time (Wave1, Wave2, and Wave 3), gender, grade, parental education level and family income.

Table 5
Results of GEE models showing the effect of DCCC scores on children’s psychological status by adjusting confounding factors.
Parameter Pressure symptoms coefficient (95% P value Anxiety symptoms coefficient (95% P value Depressive symptoms coefficient (95% P value
CI) CI) CI)

Crude model
DCCC scores 0.13 (0.10~0.16) <0.001 0.11 (0.06~0.16) <0.001 0.05 (0.04~0.06) <0.001
Adjusted model
DCCC scores 0.13 (0.10~0.16) <0.001 0.13 (0.07~0.18) <0.001 0.05 (0.04~0.07) <0.001

Note: The adjusted model adjusted for the survey time (Wave1, Wave2, and Wave 3), gender, grade, parental education level and family income.

4
P. Xiao et al.
through their self-reports, and future studies may want to obtain a full
range of information about children’s psychological status from the
perspective of parents and teachers.
5. Conclusion
In summary, our study identified a positive association between
dyslexia and children’s mental health. The results also showed no
detectable differences in the psychological status of dyslexic children
across our three surveys. Continuous and long-term follow-up studies
should be carried out so attention can be paid to changes in children’s
psychological status, and certain intervention measures should be car­
ried out for them, not only from the aspect of reading ability but also
from the perspective of mental health.
Author’s contributions
Pei Xiao and Kaiheng zhu collected data, carried out the initial an­
alyses, drafted the initial manuscript, and reviewed and revised the
manuscript; Yanan Feng, Qi Jang, Zhen Xiang, Quan Zhang, Xufang Wu,
Yixi Fan, Li Zou collected the data, carried out the initial analyses, and
reviewed and revised the manuscript. Ranran Song and Han Xiao
conceptualized and designed the study, collected data, draft the initial
manuscript, and reviewed and revised the manuscript. All authors
approved the final manuscript as submitted and agree to be accountable
for all aspects of the work.
Financial disclosures
None.
Declaration of Competing Interest
The authors declared there were no potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article.
Acknowledgments
We express our sincere gratitude to all subjects who completed our
questionnaires.
References
Abend, R., de Voogd, L., Salemink, E., Wiers, R.W., Pérez-Edgar, K., Fitzgerald, A.,
White, L.K., Salum, G.A., He, J., Silverman, W.K., Pettit, J.W., Pine, D.S., Bar-
Haim, Y., 2018. Association between attention bias to threat and anxiety symptoms
in children and adolescents. Depress Anxiety 35 (3), 229–238.
Alexander-Passe, N., 2008. The sources and manifestations of stress amongst school-aged
dyslexics, compared with sibling controls. Dyslexia 14 (4), 291–313.
Baumeister, A.L., Storch, E.A., Geffken, G.R., 2008. Peer Victimization in Children with
Learning Disabilities. Child Adolesc. Soc. Work J. 25 (1), 11–23.
Carroll, J.M., Iles, J.E., 2006. An assessment of anxiety levels in dyslexic students in
higher education. Br. J. Educ. Psychol. 76 (Pt 3), 651–662.
Costa, H.C., Perdry, H., Soria, C., Pulgar, S., Cusin, F., Dellatolas, G., 2013. Emergent
literacy skills, behavior problems and familial antecedents of reading difficulties: a
follow-up study of reading achievement from kindergarten to fifth grade. Res. Dev.
Disabil. 34 (3), 1018–1035.
Davis, K., Margolis, A.E., Thomas, L., Huo, Z., Marsh, R., 2018. Amygdala sub-regional
functional connectivity predicts anxiety in children with reading disorder. Dev. Sci.
21 (5), e12631.
de la Vega, R., Racine, M., Sánchez-Rodríguez, E., Solé, E., Castarlenas, E., Jensen, M.P.,
Engel, J., Miró, J., 2016. Psychometric properties of the short form of the Children’s
Depression Inventory (CDI-S) in young people with physical disabilities.
J. Psychosom. Res. 90, 57–61.
Ehrenstein, J.K., van Zon, S.K.R., Duijts, S.F.A., van Dijk, B.A.C., Dorland, H.F.,
Schagen, S.B., Bültmann, U., 2020. Type of cancer treatment and cognitive
symptoms in working cancer survivors: an 18-month follow-up study. J. Cancer
Survivorship 14 (2), 158–167.
Feng, Y., Ma, Y., Zhong, Q., 2019. The Relationship Between Adolescents’ Stress and
Internet Addiction: a Mediated-Moderation Model. Front. Psychol. 10, 2248.
5
Psychiatry Research 324 (2023) 115188
Firth, N., Frydenberg, E., Steeg, C., Bond, L., 2013. Coping successfully with dyslexia: an
initial study of an inclusive school-based resilience programme. Dyslexia 19 (2),
113–130.
Francis, D.A., Caruana, N., Hudson, J.L., McArthur, G.M., 2019. The association between
poor reading and internalising problems: a systematic review and meta-analysis. .
Psychol. Rev. 67, 45–60.
Gabriely, R., Tarrasch, R., Velicki, M., Ovadia-Blechman, Z., 2020. The influence of
mindfulness meditation on inattention and physiological markers of stress on
students with learning disabilities and/or attention deficit hyperactivity disorder.
Res. Dev. Disabil. 100, 103630.
Ge, Y., Xin, S., Luan, D., Zou, Z., Bai, X., Liu, M., Gao, Q., 2020. Independent and
combined associations between screen time and physical activity and perceived
stress among college students. Addict. Behav. 103, 106224.
Geisthardt, C., Munsch, J., 1996. Coping with school stress: a comparison of adolescents
with and without learning disabilities. J. Learn. Disabil. 29 (3), 287–296.
Gialluisi, A., Andlauer, T.F.M., Mirza-Schreiber, N., Moll, K., Becker, J., Hoffmann, P.,
Ludwig, K.U., Czamara, D., St Pourcain, B., Brandler, W., Honbolygó, F., Tóth, D.,
Csépe, V., Huguet, G., Morris, A.P., Hulslander, J., Willcutt, E.G., DeFries, J.C.,
Olson, R.K., Smith, S.D., Pennington, B.F., Vaessen, A., Maurer, U., Lyytinen, H.,
Peyrard-Janvid, M., Leppänen, P.H.T., Brandeis, D., Bonte, M., Stein, J.F., Talcott, J.
B., Fauchereau, F., Wilcke, A., Francks, C., Bourgeron, T., Monaco, A.P., Ramus, F.,
Landerl, K., Kere, J., Scerri, T.S., Paracchini, S., Fisher, S.E., Schumacher, J.,
Nöthen, M.M., Müller-Myhsok, B., Schulte-Körne, G., 2019. Genome-wide
association scan identifies new variants associated with a cognitive predictor of
dyslexia. Transl. Psychiatry 9 (1), 77-77.
Giovagnoli, S., Mandolesi, L., Magri, S., Gualtieri, L., Fabbri, D., Tossani, E., Benassi, M.,
2020. Internalizing Symptoms in Developmental Dyslexia: a Comparison Between
Primary and Secondary School. Front. Psychol. 11 (461), 461.
Gu, H., Hou, F., Liu, L., Luo, X., Nkomola, P.D., Xie, X., Li, X., Song, R., 2018. Genetic
variants in the CNTNAP2 gene are associated with gender differences among
dyslexic children in China. EBioMedicine 34, 165–170.
Guo, J., Ren, X., Wang, X., Qu, Z., Zhou, Q., Ran, C., Wang, X., Hu, J., 2015. Depression
among Migrant and Left-Behind Children in China in Relation to the Quality of
Parent-Child and Teacher-Child Relationships. PLoS ONE 10 (12), e0145606.
Hendren, R.L., Haft, S.L., Black, J.M., White, N.C., Hoeft, F., 2018. Recognizing
Psychiatric Comorbidity With Reading Disorders. Front. Psychiatry 9, 101.
Hoeft, F., Meyler, A., Hernandez, A., Juel, C., Taylor-Hill, H., Martindale, J.L.,
McMillon, G., Kolchugina, G., Black, J.M., Faizi, A., Deutsch, G.K., Siok, W.T.,
Reiss, A.L., Whitfield-Gabrieli, S., Gabrieli, J.D.E., 2007. Functional and
morphometric brain dissociation between dyslexia and reading ability. Proc. Natl.
Acad. Sci. U.S.A. 104 (10), 4234–4239.
Hou, F., Qi, L., Liu, L., Luo, X., Gu, H., Xie, X., Li, X., Zhang, J., Song, R., 2018. Validity
and Reliability of the Dyslexia Checklist for Chinese Children. Front. Psychol. 9
(1915), 1915.
Jin, J., Ryoko, M., Yan, H., 1998. The revision and appraisal of the pupil rating scale
revised-screening for learning disabilities. Chin. J. Child Health Care (Chin) 6 (3),
197–200.
Kessler, R.C., Foster, C.L., Saunders, W.B., Stang, P.E., 1995. Social consequences of
psychiatric disorders, I: educational attainment. Am. J. Psychiatry 152 (7),
1026–1032.
Klassen, R.M., Tze, V.M., Hannok, W., 2013. Internalizing problems of adults with
learning disabilities: a meta-analysis. J. Learn. Disabil. 46 (4), 317–327.
Kong, R., Shao, S., Wang, J., Zhang, X., Guo, S., Zou, L., Zhong, R., Lou, J., Zhou, J.,
Zhang, J., Song, R., 2016. Genetic variant in DIP2A gene is associated with
developmental dyslexia in Chinese population. Am. J. Med. Genet. Part B,
Neuropsychiatr. Genet. 171B (2), 203–208.
Krafnick, A.J., Flowers, D.L., Napoliello, E.M., Eden, G.F., 2011. Gray matter volume
changes following reading intervention in dyslexic children. Neuroimage 57 (3),
733–741.
Li, J., Zhang, W., Chen, W., Yuan, H., Zhang, S., Tian, M., Qu, Z., 2019. Applications of
the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for
children. J. Affect. Disord. 254, 109–114.
Liu, Q., Wan, Y., Zhu, B., Xie, X., Zhu, K., Jiang, Q., Feng, Y., Xiao, P., Xiang, Z., Wu, X.,
Zhang, J., Meng, H., Song, R., 2022. Association between urinary propylene oxide
metabolite and the risk of dyslexia. Environ. Pollut. (Barking, Essex: 1987 292 (Pt B),
118469.
Liu, Q., Zhu, B., Xue, Q., Xie, X., Zhou, Y., Zhu, K., Wan, Z., Wu, H., Zhang, J., Song, R.,
2020. The associations of zinc and GRIN2B genetic polymorphisms with the risk of
dyslexia. Environ. Res. 191, 110207.
Luo, Y., Wang, J., Wu, H., Zhu, D., Zhang, Y., 2013. Working-memory training improves
developmental dyslexia in Chinese children. Neural Regen. Res. 8 (5), 452–460.
Margalit, M., Zak, I., 1984. Anxiety and Self-Concept of Learning Disabled Children.
J. Learn. Disabil. 17 (9), 537–539.
Margari, L., Buttiglione, M., Craig, F., Cristella, A., de Giambattista, C., Matera, E.,
Operto, F., Simone, M., 2013. Neuropsychopathological comorbidities in learning
disorders. BMC Neurol. 13, 198.
Martínez, R.S., Semrud-Clikeman, M., 2004. Emotional adjustment and school
functioning of young adolescents with multiple versus single learning disabilities.
J. Learn. Disabil. 37 (5), 411–420.
McArthur, G., Eve, P.M., Jones, K., Banales, E., Kohnen, S., Anandakumar, T., Larsen, L.,
Marinus, E., Wang, H.-.C., Castles, A., 2012. Phonics training for English-speaking
poor readers. Cochrane Database Syst. Rev. 12, CD009115.
Miller, C.J., Hynd, G.W., Miller, S.R., 2005. Children With Dyslexia: not Necessarily at
Risk for Elevated Internalizing Symptoms. Read. Writ. 18 (5), 425–436.
Mishna, F., 2003. Learning disabilities and bullying: double jeopardy. J. Learn. Disabil.
36 (4), 336–347.
P. Xiao et al.
Nelson, J.M., Harwood, H., 2011. Learning disabilities and anxiety: a meta-analysis.
J. Learn. Disabil. 44 (1).
Ostertag, C., Reynolds, J.E., Dewey, D., Landman, B., Huo, Y., Lebel, C., 2021. Altered
gray matter development in pre-reading children with a family history of reading
disorder. Dev. Sci. e13160.
Paulesu, E., Danelli, L., Berlingeri, M., 2014. Reading the dyslexic brain: multiple
dysfunctional routes revealed by a new meta-analysis of PET and fMRI activation
studies. Front. Hum. Neurosci. 8, 830.
Qian, Y., Bi, H.-Y., 2015. The effect of magnocellular-based visual-motor intervention on
Chinese children with developmental dyslexia. Front. Psychol. 6, 1529.
Rith-Najarian, L.R., Mesri, B., Park, A.L., Sun, M., Chavira, D.A., Chorpita, B.F., 2019.
Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With
Anxiety, Depression, or Traumatic Stress:a Meta-Analysis on Long-Term Follow-Ups.
Behav. Ther. 50 (1), 225–240.
Saari, T., Hallikainen, I., Hintsa, T., Koivisto, A.M., 2020. Neuropsychiatric symptoms
and activities of daily living in Alzheimer’s disease: ALSOVA 5-year follow-up study.
Int. Psychogeriatrics 32 (6), 741–751.
Shao, S., Kong, R., Zou, L., Zhong, R., Lou, J., Zhou, J., Guo, S., Wang, J., Zhang, X.,
Zhang, J., Song, R., 2016. The Roles of Genes in the Neuronal Migration and Neurite
Outgrowth Network in Developmental Dyslexia: single- and Multiple-Risk Genetic
Variants. Mol. Neurobiol. 53 (6), 3967–3975.
Shum, A.K., Lai, E.S., Leung, W.G., Cheng, M.N., Wong, H.K., So, S.W., Law, Y.W., Yip, P.
S., 2019. A Digital Game and School-Based Intervention for Students in Hong Kong:
Quasi-Experimental Design. J. Med. Internet Res. 21 (4) e12003-e12003.
Sigurdardottir, H.M., Danielsdottir, H.B., Gudmundsdottir, M., Hjartarson, K.H.,
Thorarinsdottir, E.A., Kristjánsson, Á., 2017. Problems with visual statistical learning
in developmental dyslexia. Sci. Rep. 7 (1), 606-606.
Spreen, O., 1989. The relationship between learning disability, emotional disorders, and
neuropsychology; some results and observations. J. Clin. Exp. Neuropsychol. 11 (1),
117–140.
Srinath, A.I., Goyal, A., Zimmerman, L.A., Newara, M.C., Kirshner, M.A., McCarthy, F.N.,
Keljo, D., Binion, D., Bousvaros, A., DeMaso, D.R., Youk, A., Szigethy, E.M., 2014a.
Predictors of abdominal pain in depressed pediatric inflammatory bowel disease
patients. Inflamm. Bowel Dis. 20 (8), 1329–1340.
Srinath, A.I., Goyal, A., Zimmerman, L.A., Newara, M.C., Kirshner, M.A., McCarthy, F.N.,
Keljo, D., Binion, D., Bousvaros, A., DeMaso, D.R., Youk, A., Szigethy, E.M., 2014b.
Predictors of abdominal pain in depressed pediatric inflammatory bowel disease
patients. Inflamm. Bowel Dis. 20 (8), 1329–1340.
Sturm, V.E., Roy, A.R.K., Datta, S., Wang, C., Sible, I.J., Holley, S.R., Watson, C.,
Palser, E.R., Morris, N.A., Battistella, G., Rah, E., Meyer, M., Pakvasa, M.,
Mandelli, M.L., Deleon, J., Hoeft, F., Caverzasi, E., Miller, Z.A., Shapiro, K.A.,
Hendren, R., Miller, B.L., Gorno-Tempini, M.L., 2021. Enhanced visceromotor
emotional reactivity in dyslexia and its relation to salience network connectivity.
Cortex 134, 278–295.
Sun, Z., Zou, L., Zhang, J., Mo, S., Shao, S., Zhong, R., Ke, J., Lu, X., Miao, X., Song, R.,
2013. Prevalence and associated risk factors of dyslexic children in a middle-sized
city of China: a cross-sectional study. PLoS ONE 8 (2), e56688.
Psychiatry Research 324 (2023) 115188
Sutherland, S.C., Shannon, H.S., Ayuku, D., Streiner, D.L., Saarela, O., Atwoli, L.,
Braitstein, P., 2020. Reliability and validity of the RS14 in orphaned and separated
adolescents and youths in western Kenya. PLoS ONE 15 (11) e0241699-e0241699.
Thienkrua, W., Cardozo, B.L., Chakkraband, M.L.S., Guadamuz, T.E., Pengjuntr, W.,
Tantipiwatanaskul, P., Sakornsatian, S., Ekassawin, S., Panyayong, B., Varangrat, A.,
Tappero, J.W., Schreiber, M., van Griensven, F., 2006. Symptoms of Posttraumatic
Stress Disorder and Depression Among Children in Tsunami-Affected Areas in
Southern Thailand. JAMA 296 (5), 549–559.
Wang, F., Huang, L., Zhang, H., Jiang, H., Chang, X., Chu, Y., 2021. The mediating role of
perceived stress on the relationship between perceived social support and self-care
ability among Chinese enterostomy patients. Supportive Care in Cancer 29 (6),
3155–3162.
Wang, L.-C., 2021. Anxiety and depression among Chinese children with and without
reading disabilities. Dyslexia 27 (3), 355–372.
Wenz-Gross, M., Siperstein, G.N., 1998. Students with Learning Problems at Risk in
Middle School: stress, Social Support, and Adjustment. Except. Child. 65 (1), 91–100.
Willcutt, E.G., Pennington, B.F., 2000. Psychiatric comorbidity in children and
adolescents with reading disability. J. Child Psychol. Psychiatry 41 (8), 1039–1048.
Wilson, A.M., Deri Armstrong, C., Furrie, A., Walcot, E., 2009. The mental health of
canadians with self-reported learning disabilities. J. Learn. Disabil. 42 (1), 24–40.
Xiao, P., Zhu, K., Liu, Q., Xie, X., Jiang, Q., Feng, Y., Wu, X., Tang, J., Song, R., 2022.
Association between developmental dyslexia and anxiety/depressive symptoms
among children in China: the chain mediating of time spent on homework and stress.
J. Affect. Disord. 297, 495–501.
Xie, X., Wan, Y., Zhu, B., Liu, Q., Zhu, K., Jiang, Q., Feng, Y., Xiao, P., Wu, X., Zhang, J.,
Meng, H., Song, R., 2021. Association between urinary dialkylphosphate metabolites
and dyslexia among children from three cities of China: the READ program. Sci.
Total Environ., 151852
Xie, X., Xue, Q., Zhou, Y., Zhu, K., Liu, Q., Zhang, J., Song, R., 2020. Mental Health Status
Among Children in Home Confinement During the Coronavirus Disease 2019
Outbreak in Hubei Province, China. JAMA Pediatr. 174 (9), 898–900.
Xue, Q., Zhou, Y., Gu, H., Xie, X., Hou, F., Liu, Q., Wu, H., Zhu, K., Wan, Z., Song, R.,
2020. Urine metals concentrations and dyslexia among children in China. Environ.
Int. 139, 105707.
Yang, T.-Z., Huang, H.-T., 2003. [An epidemiological study on stress among urban
residents in social transition period]. Zhonghua Liu Xing Bing Xue Za Zhi 24 (9),
760–764.
Zhang, X., Yan, H., Yu, H., Zhao, X., Shah, S., Dong, Z., Yang, G., Zhang, X., Muse, T.,
Li, J., Jiang, S., Liao, J., Zhang, Y., Chen, Q., Weinberger, D., Yue, W., Zhang, D.,
Tan, H.Y., 2019. Childhood Urbanization Affects Prefrontal Cortical Responses to
Trait Anxiety and Interacts With Polygenic Risk for Depression. Biol. Psychiatry 85
(10), S129. Supplement.
Zhang, X., Yan, H., Yu, H., Zhao, X., Shah, S., Dong, Z., Yang, G., Zhang, X., Muse, T.,
Li, J., Jiang, S., Liao, J., Zhang, Y., Chen, Q., Weinberger, D.R., Yue, W., Zhang, D.,
Tan, H.Y., 2021. Childhood urbanicity interacts with polygenic risk for depression to
affect stress-related medial prefrontal function. Transl. Psychiatry 11 (1), 522.