E-Readers Are More Effective than Paper for Some with Dyslexia

E-Readers Are More Effective than Paper for Some with Dyslexia
Abstract

E-readers are fast rivaling print as a dominant method for reading. Because they offer accessibility options that are impossible in print, they are potentially beneficial for those with impairments, such as dyslexia. Yet, little is known about how the use of these devices influences reading in those who struggle. Here, we observe reading comprehension and speed in 103 high school students with dyslexia. Reading on paper was compared with reading on a small handheld e-reader device, formatted to display few words per line. We found that use of the device significantly improved speed and comprehension, when compared with traditional presentations on paper for specific subsets of these individuals: Those who struggled most with phoneme decoding or efficient sight word reading read more rapidly using the device, and those with limited VA Spans gained in comprehension. Prior eye tracking studies demonstrated that short lines facilitate reading in dyslexia, suggesting that it is the use of short lines (and not the device per se) that leads to the observed benefits. We propose that these findings may be understood as a consequence of visual attention deficits, in some with dyslexia, that make it difficult to allocate attention to uncrowded text near fixation, as the gaze advances during reading. Short lines ameliorate this by guiding attention to the uncrowded span.

Introduction

Computers are beginning to transform how people interact with the written word. They have spurred an evolution in the social conventions for reading that is advancing at a rate arguably unprecedented in history. Importantly, computer-based technologies present options to reformat text in ways that are customized to the needs and preferences of the individual. In addition, they allow linkage to other tools (say, for search, notes, or accessibility) that enrich the reading process and otherwise broaden access. While some of such benefits are obvious and readily grasped, the impact of other advances is less clear, and their consequences for reading are as yet unknown. Because of the extraordinary pace of development, adoption, and changes in patterns of use, research has lagged the evolution in reading. Therefore very little is known about how the new approaches to reading will influence people's abilities to decipher the written word. Here, we expand on previous studies [1] to consider the effects of e-reader formatting on dyslexia. We investigate whether approaches enabled by these technologies can address the needs of those who currently struggle with reading on paper. Given that an estimated 5% to 17% of all readers face reading impairments due to the inherited neurological effects of dyslexia [2], the potential impact of such research can be substantial.

A number of investigators have previously proposed that adjustments in formatting or display of text may facilitate reading in dyslexia. Suggestions have included modifications to fonts [3], [4], rearrangements in page formatting [1], [5], [6], as well as a variety of methods to control the dynamics of reading [7], [8]. While, in some cases, benefits were noted, the effects were generally small and, occasionally, controversial and difficult to reproduce. One notable exception are findings demonstrating that increasing inter-letter spacing facilitates reading in children with dyslexia [9], presumably by counteracting an effect known as crowding that impairs object recognition in the presence of clutter [10], an effect observed to be more severe in many people with dyslexia [7], [9], [11]–[14].

Though prevailing models of dyslexia ascribe reading difficulties to poor phonological processing, in recent years dyslexia has been increasingly associated with deficits in visual attention (e.g., [15]–[24]) and poor oculomotor control [25]–[28], prompting a suggestion [5]that e-readers could be configured to reduce demands on visual attention and oculomotor control and thus make reading less of an effort for those impaired. A reading method called Span Limited Tactile Reinforcement (SLTR) was proposed, wherein text is displayed on a small screen handheld device (such as a smartphone), using large fonts so that the text spans only a few words per line. In the SLTR method, text is advanced by manually scrolling the text vertically, as if it were a long continuous column of newsprint.

In a previous experiment [1], we used gaze-tracking techniques to compare reading on a small screen e-reader (Apple iPod Touch) with reading on a larger tablet computer (Apple iPad), and found that, when students with dyslexia read using the iPod device, oculomotor performance markedly improved over reading using the larger format. In this paper, we extend this work and consider a direct test of the SLTR reading method, using methods that focus on comprehension, as opposed to the reading dynamics studied earlier. Here, we investigate the hypothesis that SLTR, implemented on a small screen handheld e-reader (Apple iPod Touch), is more effective than the traditional approach to reading using paper, for people who struggle with reading. We investigate this question in a cohort of 103 high school students with dyslexia, using reading comprehension and speed as dependent variables. Our results show that the hypothesis is partially supported: Those among the participants who have diminished VA Spans, or difficulties with phoneme decoding or sight word processing, benefit most from the SLTR method. Together, these findings suggest that this reading method is potentially an effective intervention for struggling readers. We discuss these results in the context of deficits for visual attention and crowding, and propose a possible explanation that includes an account for the high incidence of regressive saccades in dyslexia.

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