Annals of Dyslexia (2020) 70:115–140

https://doi.org/10.1007/s11881-020-00195-w

Adults with dyslexia: how can they achieve academic

success despite impairments in basic reading
and writing abilities? The role of text structure
sensitivity as a compensatory skill

Sônia Maria Pallaoro Moojen 1 & Hosana Alves Gonçalves 2 & Ana Bassôa 3 &
Ana Luiza Navas 4 & Graciela de Jou 5 & Emílio Sánchez Miguel 6

Received: 13 March 2019 / Accepted: 10 March 2020 / Published online: 27 March 2020
# The International Dyslexia Association 2020

Abstract
The aim of this study was to investigate (1) whether a sample of highly educated
individuals with dyslexia living under optimal personal, educational, cultural, and socio-
economic conditions continues to display core deficits in reading and writing skills during
adulthood (extending prior results in Dutch, English, Hebrew, and Spanish to the
Portuguese writing system); (2) whether these individuals can compensate for the effects
of persistent core deficits when reading complex academic texts; (3) which cognitive
resources, such as reading strategies, are used as compensatory mechanisms; and (4)
whether quality of life is affected in these individuals. These questions were examined in
a sample of 28 adults with dyslexia (DG) and 28 control participants (CG) paired by sex,
age, education, and occupation, with a mean of 15 years of formal education. Participants
completed measures of phonological awareness; decoding of syllables, words, and
pseudowords; writing; reading comprehension (inferential and literal questions, recall,
and sensitivity to the rhetorical structure of the target text); and quality of life. Results
showed that (1) core deficits associated with dyslexia persisted into adulthood: partici-
pants with dyslexia performed worse than control subjects at all levels of phonological
awareness, reading (except word reading accuracy), and spelling; (2) the groups did not
differ on any measures of reading comprehension, suggesting a compensation of core
deficits; (3) three compensatory mechanisms were identified: slower reading, use of text
structure, and verbal ability; (4) participants with dyslexia required more family support
and professional help throughout their educational careers, and had more depressive
symptoms than control subjects.

Keywords Academic success . Adult university students . Dyslexia . Reading and writing abilities

* Hosana Alves Gonçalves

[email protected]

Extended author information available on the last page of the article

116 Moojen S.M.P. et al.

A very consistent finding from research on developmental dyslexia is that children with this
condition exhibit a set of core deficits in lower-level reading processes as those involved in
deciphering the alphabetic code (Schneider & Chein, 2003) and automatic word recognition
(Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001). Consequently, dyslexic children show
lower performances than typical readers during phonological awareness and word reading
tasks, especially those involving pseudo and low frequency words (Bogdanowicz, Łockiewicz,
Bogdanowicz, & Pąchalska, 2014; Reid, Came, & Price, 2008; Shaywitz, 2006). Besides, two
specific consistent findings are supporting the present study:

1. Children with dyslexia tend to experience problems in reading comprehension (Bruck,

1990; Sánchez, González, & García, 2007) as a consequence of the inefficiency of lower-
level reading processes that leaves fewer resources available for higher-level processes
(McNamara & Magliano, 2009).
2. Core deficits present in children with dyslexia persist in adults even though it is not so
evident if reading comprehension remains affected (Bruck, 1990; Snowling, Muter, &
Carroll, 2007; Undheim, 2003). Highly educated dyslexic adults may use compensatory
strategies to overcome the core deficits (Gregg, Coleman, Davis, & Chalk, 2007;
Mortimore & Crozier, 2006; Pedersen, Fusaroli, Lauridsen, & Parrila, 2016; Ransby &
Swanson, 2003).

The present study aims to investigate whether individuals living under optimal personal,
educational, cultural, and socioeconomic circumstances can compensate for their persistent
core deficits during complex text comprehension tasks. We also sought to identify the
cognitive resources, such as reading strategies, which can help highly educated individuals
with dyslexia succeed in such complex reading tasks.
Before investigating these issues, we need to confirm the presence of persistent core deficits in
Portuguese-speaking individuals, which expand findings from previous research in Dutch, English,
Hebrew, and Spanish. Additionally, it is the starting point to explore more specific questions, and
potential contributions just mentioned: if, despite these core deficits, they can compensate for
comprehension and, especially, to find out how could do it in facing complex texts.

Core deficits associated with dyslexia persisted into adulthood

As previously mentioned, there is currently a broad consensus in the literature regarding the
persistence of deficits in phonological awareness, poor word reading accuracy, and lack of
reading fluency in adult individuals with dyslexia. Phonological awareness is involved in the
acquisition of the alphabetic code and mediates phoneme/grapheme correspondences. Some
studies have shown that adult individuals with dyslexia perform poorly in measures of
phonological awareness compared with controls with similar grade levels (Boets et al.,
2013; Callens, Tops, & Brysbaert, 2012; Rueda Sánchez & Sánchez Miguel, 2011). Further-
more, reading accuracy has also been found to be impaired in individuals with dyslexia
(Leinonen et al., 2001; Judge, Caravolas, & Knox, 2006), especially in readers of opaque
orthographies (Callens, Tops, & Brysbaert, 2012). Lastly, text fluency problems have also been
reported in adults with dyslexia, as well as difficulties in pseudoword reading (Bruck, 1990,
1992; Hatcher, Snowling, & Griffiths, 2002; Nergård-Nilssen & Hulme, 2014; Parrila,
Georgiou, & Corkett, 2007; Shaywitz et al., 1999; see Swanson & Hsieh, 2009 for a review;
Adults with dyslexia: how can they achieve academic success despite... 117

Nergård-Nilssen & Hulme, 2014; Suárez-Coalla & Cuetos, 2015). These issues take the form
of slow and effortful reading, difficulties decoding polysyllabic words, as well as frequent
spelling errors (APA, 2013; Suárez-Coalla & Cuetos, 2015). Another critical aspect of reading
fluency involves using adequate prosody (Kuhn, Schwanenflugel, & Meisinger, 2010). The
effort required in word decoding may prevent individuals from using appropriate prosodic
patterns when reading, which can lead to impairments in comprehension (Alves, Reis,
Pinheiro, & Capellini, 2009). Unfortunately, reading fluency of adults with dyslexia has not
been sufficiently investigated.
A similar pattern has emerged in writing (Bowers & Wolf, 1993). Studies with dyslexic
university students have shown that, while many have accurate coding of words and letters,
their writing speed is slower than expected (Shaywitz, 2006). A slow writing rate, in turn, can
interfere with the ability to take notes while attending a lecture in individuals with dyslexia
(Mortimore & Crozier, 2006; Re, Tressoldi, Cornoldi, & Lucangeli, 2011).
In sum, these studies have found that core deficits may still be identified in adults,
regardless of the schooling level and (to a certain degree) of the orthographic depth (see
Suárez-Coalla & Cuetos, 2015). However, there is still disagreement about whether reading
comprehension is also impaired in adults with dyslexia, as described in the next section.

What is known about associated problems in reading comprehension

An explanation for reading comprehension deficits

According to the extended view of cognitive processing described by the verbal efficiency
theory (Perfetti, 1985, 1988) and the simple view of reading (Gough, Hoover, & Peterson,
1996; Hoover & Gough, 1990), the inefficiency of lower-level reading processes may place
additional demands on working memory (WM). Such cognitive overload is a consequence of
fewer resources for higher-level processes involved in text comprehension, such as extracting
information from words and sentences to elaborate propositional meanings (Im &
Lombardino, 2016; Kintsch & Walter Kintsch, 1998). It is also necessary to build a proposi-
tional network locally and globally coherent with recursive mapping and inference processing
(McNamara & Magliano, 2009; O'Brien & Cook, 2016). If text continuity and coherence are
not achieved, readers would have to use strategic resources to achieve adequate comprehen-
sion levels (Graesser, 2007). Note, however, that these higher-level processes required to
generate a coherent representation of text are not unique to reading. They are equally involved
in verbal comprehension and other forms of communication, none of which appear to be
impaired in individuals with dyslexia. Not surprisingly, verbal comprehension skills have been
found to modulate the influence of decoding on reading comprehension (see García & Cain,
2014 for a meta-analysis; Uccelli et al., 2015), which raises the possibility that additional
variables may play a similar compensatory role (Ransby & Swanson, 2003). Furthermore,
studies comparing adults with dyslexia to typical readers paired by age and education level
have found that verbal comprehension can provide variable compensation for impairments in
word recognition.
As such, Lefly and Pennington (1991) estimated that 22 to 25% of children with dyslexia
would eventually compensate for their initial difficulties, a hypothesis that has received some
empirical support, as seen in the literature (Bruck, 1990; Conners & Olson, 1990). A more
precise estimate was obtained by Ransby and Swanson (2003), who used a hierarchical
118 Moojen S.M.P. et al.

regression analysis to evaluate higher and lower-level processes in adults with dyslexia and
typical readers matched by chronological age and reading level. The authors found that both
higher- and lower-level processes accounted for a significant amount of variance in reading
comprehension. Interestingly, oral language skills were also found to influence reading
comprehension, in addition to accuracy and fluency.
Finally, García and Cain (2014) performed a meta-analysis study in which they found that,
even though decoding skills predicted reading comprehension throughout literacy develop-
ment (including university-level samples), the extent of this influence declines to start at age
11. Therefore, if the effects of decoding decrease over time, it seems that reading experience
and print exposure (Stanovich, 1986) may be critical for understanding the potential compen-
satory role of higher-order skills. These highlight the relevance of studying highly educated
adults with dyslexia who have had sustained an extensive engagement with reading throughout
their academic life.
The critical issue, therefore, is not whether oral language compensates for lower level
reading skills, but whether adults with dyslexia, especially those with high education levels,
can achieve similar reading comprehension levels as typical readers despite their persistent
core deficits (decoding). Beforehand, it is essential to clarify which are the reading challenges
for adults with dyslexia vs. typical readers.

Managing academic text: what are the challenges involved in a reading to learn
experience

Reading comprehension of academic or expository texts that aim to present new information of a
complex and unfamiliar topic requires acquisition of skills that are not usually necessary to handle
the type of text one may encounter daily (Meyer, 1975; Duke & Roberts, 2010), in which decoding
and oral comprehension are the critical skills involved according to the simple view of reading.
Students must acquire a set of sophisticated strategic resources, such as summarizing,
selecting, organizing, and revising text information (McNamara, 2007, Snow, 2002). They
also develop the ability to exploit the rhetorical devices on the written text that reveal the
author’s communicative intentions and work as a handbook to mobilize such strategies just
when they become useful during text reading (Sánchez & García, 2009, and Sánchez, García,
& Bustos, 2017 for the notion of rhetorical competence). As an example, the target strategy
considered in this study is a potential compensatory device for adults with dyslexia (Hebert,
Bohaty, Nelson, & Brown, 2016; Meyer, Brandt, & Bluth, 1980; Williams et al., 2014). This
strategy makes readers sensitive to textual cue words as “A second factor” that reveal the
structure of the text, pushing them to use such structure to undertake the strategic actions of
selecting and organizing the ideas from text accordingly. Without such strategies, managing
the complex and unknown information delivered by the text would be not accessible.
Good decoders with an adequate oral comprehension level may fail in facing expository
texts; they may be insensitive to these cues and, as a consequence, they cannot use strategies
that they do possess (Gersten, Fuchs, Williams, & Baker, 2001; Sánchez, García, & Bustos,
2017), or they lack such strategies. As such, higher educated adults with dyslexia could offer a
contrasting scenario: they are poor decoders, but they can use the structure strategy and
rhetorical cues as a guide to seek specific information (“I am going to find out in this paragraph
which is the cause..”), thus compensating for their poor word recognition. Interestingly,
Corkett, Parrila, and Hein (2006) have found that university students with dyslexia—but not
Adults with dyslexia: how can they achieve academic success despite... 119

high school students—report greater use of organizational strategies than typical readers. This
study investigates this hypothesis.

What is known about the persistence of reading comprehension problems in adult

dyslexics

As suggested above, the evidence on the persistent reading comprehension deficits in adults with
dyslexia is not conclusive. Ransby and Swanson (2003) studied a group of 20 young adults (mean
age = 19.05 years old) who had attended a specialized primary school for the treatment of
developmental dyslexia compared with two control groups: age and socioeconomic status (SES)–
matched typical readers (n = 20), and children (mean age = 12.05 years old) matched by SES and
reading level (n = 20). The three groups were compared on measures of phonological processing,
naming speed, working memory (WM), general knowledge, vocabulary, and comprehension. The
assessment of fluid intelligence identified no significant difference between individuals with
dyslexia (mean IQ = 98.27; SD = 11.14) and adult controls (IQ = 111.2; SD = 8.47), but found that
mean IQ was lower in both adult groups compared with the children (IQ = 134; SD = 30.58).
Reading comprehension was evaluated by silent reading, followed by multiple-choice questions
about a series of passages. Reading speed was assessed by giving participants 3 min to complete the
silent reading of one-page stories interspersed with 30 highlighted lines containing three words each.
At each line, participants had to select the word which best completed that section of the story. The
measure used as reading speed was the number of correctly chosen words in 3 min. No differences
were observed in lower order reading skills, fluency, or comprehension between control subjects and
adults with dyslexia. However, the latter outperformed the children in measures of lexical
processing, WM, and listening comprehension, when word recognition and intelligence were
excluded from the analysis.
It is important to note that the study does not mention the education level of the adult
participant groups.
Simmons and Singleton (2000) compared ten university students with dyslexia (mean age =
27.6; SD = 12.22) with ten control subjects (mean age = 21.4; SD = 3.53) in order to identify
any group differences in reading comprehension. Only one of the individuals with dyslexia had
completed an undergraduate degree. Participants performed a word recognition task, which
revealed significant differences between the two groups. Reading comprehension was evaluat-
ed using a long, syntactically complex text. The 655-word piece was followed by ten multiple-
choice questions (five literal and five inferential). Participants could refer to the text to answer
the questions. The groups did not differ in their performance on literal questions, though
participants with dyslexia had more difficulty with inferences and poorer decoding skills than
the control group. Mean IQ of each participant group was not presented, and the study does not
describe how the groups were matched or whether they differed significantly in age.
These studies suggest that adults with dyslexia may have difficulties with reading comprehension.
However, other research has found that despite difficulties in phonological awareness, accuracy, and
fluency, these individuals may not always show impairments in reading comprehension.
Parrila, Georgiou, and Corkett (2007) examined this issue and, in doing so, identified the
importance of untimed comprehension tasks. The authors evaluated both lower-level (word and
non-word reading, spelling, phonological processing) and higher-level processes in 28 university
students with a self-reported history of reading acquisition problems and compared these participants
with a control group. Reading comprehension was examined in all subjects using the Nelson-Denny
Reading Test, Form H, which contains seven passages and 38 multiple-choice questions. Since most
120 Moojen S.M.P. et al.

participants with dyslexia were unable to complete the test before running out of time (20′), a percent
accuracy score was calculated for the comprehension questions, in order to provide an untimed
measure of comprehension in addition to the standard score calculated at the end of the allotted time.
The untimed comprehension score was the only measure in which no differences were identified
between the two participant groups.
In another study on reading comprehension, Nielsen et al. (2016) compared the perfor-
mance of 81 individuals with dyslexia with that of 50 of their relatives, who served as control
participants. These individuals were 16 to 25 years old and consisted of siblings, cousins, and
other close relatives of the clinical sample. Individuals with dyslexia (verbal IQ = 112.29; SD
= 10.26) had significantly higher intellectual ability than control participants (verbal IQ =
104.34; SD = 11.72). Education levels varied widely in the sample and were distributed as
follows: 47.5% of participants had not completed high school, 11.1% had a high school
degree, 21% had graduated from a community college or technical school, and 8.6% (n = 7)
had a college degree. Participants were evaluated using The Passage Comprehension subtest
from the Woodcock-Johnson Psycho-Educational Battery–Revised. The study did not find any
differences between individuals with dyslexia and control subjects in reading comprehension
as measured by a cloze test. However, the two participant groups did show significant
differences in word recognition ability with lower scores for the dyslexic group.
In conclusion, these studies clearly show that adults with dyslexia show varying degrees of
compensation for core deficits in reading comprehension. The findings suggest that both oral
language skills and a slow and careful reading may provide compensatory mechanisms for these
individuals. However, there is still no agreement as to whether individuals with dyslexia can match
the performance of typical readers, and it is difficult to find an explanation for discrepant results in
this regard. The studies differ with respect to participants’ academic levels, matching variables for
clinical and control groups (age, verbal and non-verbal IQ, socioeconomic status, educational level),
the tasks used to evaluate reading comprehension (cloze type, open-ended, or multiple-choice
questions), and the type of text given to participants (standardized vs. experimental texts). Further-
more, the multiple definitions used for dyslexia may influence the studies’ design (Vellutino,
Fletcher, Snowling, & Scalon, 2004). Hence, there is a need for new studies that provide a clear
description and justification for the selection of control variables, tasks, and reading conditions,
given that all variables may influence the compensatory mechanisms used by individuals with
dyslexia. In the present study, we used a complex expository text selected for its similarity to
schoolwork to evaluate participants.

What is known about socioemotional issues in adults with dyslexia

The persistent difficulties in reading and writing associated with dyslexia may not only
compromise individuals’ academic performance but also contribute to socioemotional issues
such as anxiety, low self-esteem, and other internalizing disorders, which in turn interfere with
peer relationships (Klassen, Tze, & Hannok, 2013). A study conducted by Jordan,
McGladdery, and Dyer (2014) found that adults with dyslexia exhibit high levels of anxiety,
which can lead to difficulties in several academic areas, such as mathematics. Studies have also
indicated that the ability to compensate for difficulties associated with dyslexia may decrease
anxiety levels (Meer, Breznitz, & Katzir, 2016).
The process of learning these compensatory strategies requires high levels of effort, with
considerable cognitive and emotional costs, regardless of the age range, even for adults with no
Adults with dyslexia: how can they achieve academic success despite... 121

learning difficulties (Rodarte-Luna & Sherry, 2008). In the case of people with dyslexia, it is
frequent that the gains obtained are minimal concerning the high efforts. Apart from taking
longer to learn, dyslexic people tend to have fewer successful opportunities, which in turn
increases the amount of isolation from school peers (Kormos, Csizer, & Sarkadi, 2009).
During specific situations of complex problem solving, students experience frustration, bore-
dom, confusion, and anxiety (D'Mello, Lehman, & Person, 2010). Dyslexic students may
experience a path of unsuccessful schooling and thus develop negative emotions. These
persistent feelings may lead to low self-esteem, and poor self-efficacy and consequently
develop depressive symptoms.
Socioemotional consequences of dyslexia have been studied for some time now
(Livingston, Siegel, & Ribary, 2018; Riddick, Sterling, Farmer, & Morgan, 1999). The evident
emotional consequences derived from dyslexia motivated the organization of several books
and other resources that aim to explain how to deal with dyslexia through life (e.g., Burden,
2010; Riddick, 2009). Even though dyslexia is considered a specific learning disorder, many
individuals with dyslexia associate their ability to read and write to their intellectual capacity.
Thus, low accuracy and slow reading are interpreted very often by dyslexics as a sign of poor
intelligence. This type of thought is related to lower self-esteem and feelings of incompetence,
especially about written and academic achievements.
There are several pieces of evidence of such emotional consequences as described by
Livingston, Siegel, and Ribary (2018). Apart from depression, dyslexia has been associated
with social anxiety disorders (Carroll & Iles, 2006), conditions that contribute to the frequent
decision not to attend higher education.
According to the literature, family support and adequate management strategies in school
settings are crucial for individuals with dyslexia, since the lack of specialized support may
negatively impact their socioemotional status (Carawan, Nalavany, & Jenkins, 2016; Claassens
& Lessing, 2015; Rueda Sánchez & Sánchez Miguel, 2011). Therefore, given the negative
impact of dyslexia on socioemotional factors, which, in turn, interfere with academic out-
comes, and so these factors must be investigated. It is then crucial to identify the presence of
depressive symptoms on a population of dyslexic adults who achieve academic success and
investigate their reading and writing basic abilities, phonological awareness, and intellectual
level. Additionally, it is crucial to know whether academic success of these dyslexic adults
may be explained by the absence of depression and low self-esteem (Quiroga, Janosz, Bisset,
& Morin, 2013), since socioemotional resilience is fundamental for a good functional outcome
in reading disabilities (Haft, Myers, & Hoeft, 2016).

The present study

This study aims to analyze the development of lower- and higher-order skills in a carefully
selected sample of successful adults with dyslexia exposed to optimal personal, family,
and cultural circumstances. More specifically, this study focused on skills associated with
word and pseudoword recognition (accuracy and speed), and underlying processes such as
phonological awareness, which tend to be the locus of core deficits in dyslexia. In addition
to the lower level skills involved in reading comprehension, we analyzed participants’
ability to identify written text structure using a strategy acquired from experience with
complex texts in the context of elementary and higher education. A complex academic text
was used where the links between ideas follow a problem-solution-result pattern. The
present study involves two comprehension tasks. The first consisted of silent reading
122 Moojen S.M.P. et al.

followed by an oral retelling, which allowed us to determine how much information

participants were able to recall, and the extent to which they relied on the text structure
to master the task. The second measure of reading comprehension required that partici-
pants read a text out loud before answering a series of literal and inferential questions.
Reading times were recorded in both silent and oral conditions.
The study addresses five main questions:

1. Do core deficits associated with dyslexia persist in adulthood? The presence of core deficits in
our sample with optimal characteristics would extend existing findings from English, Dutch,
Spanish, and Hebrew (Suárez-Coalla & Cuetos, 2015) to the Brazilian Portuguese orthography.
The exceptional conditions of the present sample will help determine whether a successful
educational experience allows individuals to overcome impairments in word recognition. Such
findings would disagree with previous data and suggest that under exceptional circumstances,
these adults with dyslexia may overcome the core deficits and associated impairments. On the
other hand, the detection of such impairments in the present sample would provide robust
evidence of the persistence of core deficits in dyslexia.

2. Is the performance of highly educated individuals with dyslexia on reading comprehen-

sion tasks (recall, literal, and inferential questions) like that of control participants? An
affirmative answer to this question would suggest that it is possible to compensate for
persistent core deficits in the comprehension of complex academic texts.

3. Do highly educated individuals with dyslexia rely on text structure strategies to the same
extent as typical readers?

4. Could this sophisticated strategy allow highly educated individuals with dyslexia to
compensate for other impairments when carrying out typical academic tasks, such as
answering questions or remembering the content of a passage? If so, this may be one of
the most critical findings in the present study given that it could explain how individuals
with dyslexia compensate for their core deficits instead of merely showing that they could
compensate as it has been documented in prior studies. This result also opens the
possibility to design more specific interventions to support people with dyslexia.

5. Given that the structure strategy can only be developed through sustained educational engage-
ment that involves constant and daily reading activities that provide demanding experiences for
dyslexic students, we expect that these successful dyslexic adults can exhibit unhappier self-
assessment, anxiety, and depression compared with typical readers. An affirmative answer to
this question would corroborate previous findings regarding the long-term consequences of
socioemotional issues associated with this condition. Furthermore, the absence of depressive
symptoms and adaptive difficulties may be factors that influenced the attenuation of the
functional deficits in reading, which in turn may have promoted academic success.
Adults with dyslexia: how can they achieve academic success despite... 123

Methods

Sample

The sample consisted of 28 adults (14 males and 14 females) with dyslexia (DG) aged between
18 and 67 years. All participants were evaluated in a private clinic, specialized in learning
disorders, by the same team of health professionals. Sixty-one percent of these individuals
were diagnosed with dyslexia during their childhood or adolescence at the clinic where the
study was conducted, and 92.8% received professional help to manage their symptoms or
assist with academic difficulties (educational psychologist, 46.4%; clinical psychologist, 75%;
private tutor, 71.4%; speech and language therapist, 17.9%). Participants had high levels of
education (11 to 22 years), were currently or previously enrolled in institutions that received
favorable ratings from the Brazilian Ministry of Education (64% attended institutions which
received a General Course Index score of 4 on a scale of 1 to 5 points), and most belonged to
highly educated families (67% had undergraduate or graduate degrees).
The following inclusion criteria were applied to participants with dyslexia: age of at least
18 years, Brazilian Portuguese speakers, at least 1 year of undergraduate study, IQ of at least
85, persistent difficulties in reading and writing with no other recognized cause (sensory
impairments, neurological conditions, or low education levels).
Participants in the control group (CG) had no difficulties in reading or writing and were
matched to participants with dyslexia in a 1:1 ratio based on gender, age, occupation, and
education level. Control participants had 11 to 22 years of education and were evaluated by the
same research team. Table 1 describes the profile of the participants for this study.

Procedures and instruments

This study was approved by the Research Ethics Committee of the Hospital Moinhos de
Vento-RS (Brazil), CEP/IEP-AHMV: 2010/45, and was conducted according to all recom-
mendations of law 466/2012. All subjects provided written consent for participation. Partic-
ipants with dyslexia were selected from the records of all patients seen by one of the authors of
the present study in a private clinic specialized in learning disorders. All patients were initially
Table 1 Sociocultural and intellectual characteristics of the sample

DG CG p
M (SD) M (SD)

Age in yearsa M (SD) 34.11 (13.40) 34.43 (13.96) 0.93

Years of educationa M (SD)* 15.43 (2.45) 16.26 (2.81) 0.15
Number of grades repeated in yearsa M (SD) 1.64 (1.81) 0.57 (0.92) 0.007
WAIS-III Total IQa M (SD) 111.52 (7.52) 118.86 (9.21) 0.001
Verbal IQa M (SD) 105.34 (10.12) 115.44 (10.03) 0.000
Performance IQa M (SD) 118.28 (8.32) 119.60 (8.58) 0.54
Education level Some university (n)c 42.9 50.0 0.48
Undergraduate degree (n)c 32.1 17.9 0.43
Graduate degree (n)c 25 32.1 0.41

*The repeated grades were not included in years of education

a Student’s t test
c Chi-square test = 0.48
DG, dyslexic group; CG, control group; IQ, intelligence quotient
124 Moojen S.M.P. et al.

referred to the clinic by schools or health professionals due to academic difficulties. These
individuals were later diagnosed with dyslexia, either in childhood, adolescence, or adulthood.
The control group was selected by convenience through personal acquaintances and contacts.
To ensure the groups were adequately matched, we recruited the participants via e-mail and
flyers containing detailed information on eligibility criteria (i.e., age, gender, occupation, and
education level). Volunteers with the desired characteristics were contacted by telephone to
schedule the first assessment session. Subjects took part in four 60-min sessions, in which they
completed the screening procedures for inclusion criteria, measures of reading and writing, and
all remaining assessment instruments. The sessions were conducted in the following order, for
both participant groups: initial interview and questionnaires, reading and writing tasks,
assessment of intellectual ability, and quality of life.

Instruments used to screen for inclusion criteria and investigate participant

characteristics

1. Wechsler Adult Intelligence Scales (WAIS III) (Nascimento, 2005; Wechsler, 1997):
Participants completed the full version of this instrument to allow for the calculation of
verbal, performance, and full-scale IQ, and the scores classified as recommended by the
test manual.
2. Clinical and sociocultural questionnaire: This instrument was developed specifically for the
present study in order to collect information on the education levels of participants and relatives,
professional qualifications and current occupation, a history of grade repetition, professional
assistance (incl. speech and language therapists, educational psychologists, clinical psycholo-
gists, or private tutors). The questionnaire also asked participants to name any universities they
had attended, so that researchers could evaluate the quality of their higher education as per the
General Course Index (Índice Geral de Cursos; IGC). The IGC is the standardized mean of
ratings provided to all graduate and undergraduate courses of a given institution in Brazil. It,
therefore, reflects the overall quality of universities/colleges based on evaluations of the
undergraduate and graduate courses they offer. The IGC ranges from 1 to 5 points. Courses
with a score of 1 or 2 are considered unsatisfactory and are placed under the supervision of the
Ministry of Education (Ministério da Educação; MEC).

Instruments used to evaluate reading, writing, and phonological awareness

Lower level reading skills

Decoding

(i) Pseudoword decoding: this skill was evaluated using a section of the instrument devel-
oped by Parente, Hosogi, Delgado, and Lecours (1992), with ten pseudowords, with ten
additional items drawn from the Word and Pseudoword Decoding Test developed by
Moojen and Costa (2007) (França, 2007). So, participants were asked to read 20
pseudowords. Since the words were drawn from two different tests (one of which also
contained real words), the total number of errors were recorded.
(ii) Word decoding: the ability to decode isolated words was examined using the 40-word test
developed by Moojen and Costa (2007) (França, 2007), and the total number of errors was
used as a measure of word decoding.
Adults with dyslexia: how can they achieve academic success despite... 125

(iii) Complex syllable task (Moojen, in construction): phonological reading skills were evaluated
using a set of 136 complex syllables that is syllables that did not follow the CV pattern. The
time to complete the task, and the percentage of incorrect items were recorded.

Phonological awareness
Phonological awareness task for adults (Moojen, in construction): this instrument evaluates
the skills associated with phonological awareness in adults. It contains sixty pseudowords
which help examine syllable deletion, syllable transposition in di- and trisyllabic words,
rhyming, as well as phoneme segmentation, deletion, and transposition. The total time required
to complete the test is also calculated by adding up the time taken by participants to complete
each subtest (syllable and phoneme).
Writing

(i) Balanced spelling—Ditado Balanceado (Moojen, 2011): This instrument is a spelling

dictation test that contains a list of 50 words containing the most common spelling
difficulties in Brazilian Portuguese, reflecting the frequency of each letter as closely as
possible. Spelling errors are classified into the following categories: phoneme–grapheme
correspondences (PGC), simple contextual rules (SCR), complex contextual rules/syllable
stress (CCR), and linguistic irregularities (IR). The errors classified as phoneme–
grapheme correspondence are exchanges, omissions, additions, among others that
disagreed with alphabetic principle; the errors classified as simple contextual rules
indicate that an orthographic rule was ignored, as well as may show failure to assign
nasalization; complex contextual rules/syllable stress include errors of stress marks;
finally, errors classified as linguistic irregularities refer to errors that cannot be explained
by orthographic rules. The results indicate the raw score of total errors and the number of
errors in each category. Normative data for this instrument are available just for lower-
and upper middle-class children in grades 3 through 8.
(ii) Essay writing: All participants were asked to handwrite an autobiographical essay on the
topic of “My educational history.” The number of words written, as well as the number and
percentage of errors, were calculated for each participant. The essays were later submitted to
content analysis (Bardin & Bardin, 1977) in order to investigate how participants perceived
their academic experience. This method allowed for different experiences to be categorized
(9 categories) and compared between individuals with dyslexia and control participants. We
recorded the frequency of text productions in each category.
(iii) Spelling test for high school seniors: This instrument was developed by Moojen (2002,
unpublished manuscript), and contains 24 orthographically challenging irregular words
(words that show a deep grapheme–phoneme correspondence that cannot be explained
by an orthographic rule).

Higher level skills

Reading comprehension
Reading comprehension was evaluated using a passage about the “Dead Sea Project”
(Saraiva, Moojen, & Munarski, 2006). The passage has 348 words (mean of 24.6 words per
sentence), 63 information units (propositions), and a complex rhetorical structure with seven
categories, consisting of a repetition of the problem-solution pattern: (1) problem-solution-
result (1 positive result and 1 negative result or problem), (2) solution-result (1 solution and 2
126 Moojen S.M.P. et al.

positive results), that is not entirely transparent since there are only two organizational signals
in the text. This is an academic text on an unfamiliar subject, suitable for use with adults.
Though the passage has not been subjected to validation studies, the fact that neither group
surpassed the 70% accuracy rate on comprehension questions provides strong evidence of its
complexity. Though the text contains only two rhetorical devices that reveal its underlying
structure, the problem/solution pattern is usually recognizable to highly educated individuals.
Reading comprehension was evaluated by first asking participants to read the passage silently
and retain the information for later recall. The time taken for this initial reading was recorded.
After the silent reading, participants were asked to recall what they remembered from the text.
Each subject was then asked to read the text out loud in order to accomplish a questionnaire
task. The second reading was timed and audio-recorded for further analysis of reading fluency,
including prosodic cues. Participants were then asked ten comprehension questions that
covered the main ideas in the text.
All stages of the assessment were audio-recorded for later transcription and analysis. This
allowed for an assessment of fluency (prosody and number of words read per minute) and
speed (total time in seconds for silent and overt reading) in addition to reading comprehension.
Three different comprehension measures were therefore obtained from each participant:
recall, sensitivity to text structure, literal, and inferential questions.
Reading comprehension: free recall
Results were analyzed by expert judges, blind to participant groups. The spoken summaries
of the text were analyzed by calculating the number of propositions recalled by participants
after the first (silent) reading of the text. The calculation was performed as outlined by Kintsch
and van Dijk (1978) and scored out of a maximum of 63 points.
Two blind raters independently analyzed 15% of responses in order to develop a standard-
ized method to assess and score the information recalled by participants. The kappa coefficient
demonstrated substantial agreement between raters (kappa = 0.76; p < 0.001). Therefore, only
one rater went on to assess the remaining participants.
Reading comprehension: sensitivity to text structure
In order to determine whether participants were able to identify the text structure and use
this information to complete the task, we collected two measures. The number of the rhetorical
categories attended in the recall and the whole pattern exhibited in the recall.
Participants’ ability to identify the text structure was evaluated by three blind judges, who
independently analyzed 11% of responses. The kappa coefficient between judges 1 and 2 was
0.76 (p < 0.001), while that observed between judges 1 and 3 was 0.72 (p < 0.001). Lastly, the
agreement coefficient between judges 2 and 3 was 0.74 (p < 0.001). After the inter-rater
agreement was confirmed, only one judge was asked to score the remainder of the sample.
This analysis was used to identify the categories and to classify each verbal account
into one of the following three global patterns: no explicit organization (i.e., a list of
ideas); problem-solution (when this was the only pattern identified in the participant’s
response); and problem-solution-result, the most complex pattern of all. Besides, we
computed the number of propositions (max 24) that express a direct connection among
propositions (Kintsch & Walter Kintsch, 1998) such as “P3 cause, P1, P2,” trying to
capture the degree of which participants provided a coherent account of the text on
their recalls.
Reading comprehension: literal and inferential questions
The overt reading was followed by a series of questions about the text. Participants could
receive a maximum score of 10 for their answers to literal (7) and inferential questions (3).
Adults with dyslexia: how can they achieve academic success despite... 127

Literal questions referred to details (e.g., “What are some characteristics of the Dead Sea?”)
and main ideas in the text (e.g., “What are the goals of the project?”). These questions were
read by the examiner, and participants were asked to provide an answer without looking back
at the passage.
In addition to reading comprehension, the number of words read per minute, reading time,
and prosodic variation were also evaluated.
Fluency
Reading fluency (words per minute and prosody) was evaluated using the acoustic
analysis of recordings while participants read the middle section of the text. The Praat
software was used to analyze the sound waves, including their duration (in seconds).
Repeated words and syllables, but not pauses, were excluded from the analysis.
Prosody
Prosody was evaluated by three qualified judges, blind to participant groups. The
audio recordings of the text reading were randomly distributed to the judges, who were
asked to score the quality of text reading prosody on a three-point scale (0 to 2).
“Inadequate prosody” during text reading received a score of 0, a score of 1 suggested
“Insufficient prosodic variation,” and a score of 2 indicated “Adequate prosody.” The
subjective classification of prosody in reading should consider adequacy in terms of (1)
expressiveness (reading like natural language, enthusiasm, and emphasis), (2) speed
(perceptive reading rate, the presence of long pauses), and (3) intonation (fundamental
frequency variation according to the syntactic text structure). The interjudge agreement
was 100%.

Socioemotional assessment instruments

1. Beck Depression Inventory (BDI-II) (Cunha, 2001): this is a self-report instrument which
evaluates signs of depression. Scores are classified as follows: 0 (no signs of depression),
1–9 (minimal signs of depression), 10–18 (mild to moderate), 19–30 (moderate to severe),
and 31–63 (severe).
2. WHOQOL-Bref (Fleck et al., 2000): this is an internationally recognized measure of
quality of life, containing questions divided into four major domains, i.e., physical,
psychological, environmental, and social.

Statistical analysis

Participant characteristics were analyzed using descriptive techniques. Group differ-

ences were assessed using Student’s t test for parametric variables and Mann-Whitney
tests for non-parametric variables. Because the age difference varies widely among
participants, all scores for dependent variables and sample characterization were com-
pared between the control and dyslexic participants using an ANCOVA with age as
covariate.
Chi-square tests were used to compare categorical variables, considering that IQ, reading
speed, and the ability to identify the text structure are factors frequently associated with the
ability to understand texts. An analysis correlation (Pearson) was run to identify whether in our
sample, the expected correlation is indeed observed, and if this relation occurs similarly for the
128 Moojen S.M.P. et al.

control and dyslexics. Besides that, the impact of different factors on reading comprehension
was analyzed using stepwise linear regression. Thus, to determine whether structure sensitivity
makes a unique contribution to the comprehension of expository text, we have conducted one
fixed-order hierarchical multiple regression. In the first step, we entered IQ verbal because it
represents the global verbal skills of the participants. In the second step, we entered the
measure of structure sensitivity or reading speed. Results were considered significant at
p < 0.05, and data were analyzed using the SPSS, version 17.0.

Results

Sample characteristics

The sociocultural and intellectual characteristics of the sample are shown in Table 1.
As shown in Table 1, the groups are similar in age and education levels, though participants
with dyslexia showed a higher number of grade repetitions. Although all participants had
average IQ scores (57% of values were classified as medium-high), individuals with dyslexia
showed significantly poorer verbal skills and consequently, a lower verbal IQ than the control
group. However, no differences were observed in performance IQ scores, which were classi-
fied as medium-high for most participants in both groups. We therefore believe that given their
high education levels and IQ scores, in addition to how they were recruited, participants in the
present study are likely to come from an upper middle-class background.
These and other findings of the present study will now be discussed concerning the five
research questions guiding this study.

Do the core deficits associated with dyslexia persist into adulthood?

Phonological awareness The analysis of overall performance (number of errors) in the Adult
Phonological Awareness Test showed that individuals with dyslexia performed worse than control
subjects in most tasks involving syllables, phonemes, and rhyme. They also took longer than
control subjects to complete these same activities (Table 2).

Decoding and writing Individuals with dyslexia produced significantly more errors than
control participants in most of the tasks as shown in Table 3. More specifically, the analysis
of reading accuracy showed that individuals with dyslexia present more errors than control

Table 2 Participant performance in phonological awareness tasks

DG CG p

Syllable Total errors (/30)b M (SD) 6.46 (3.68) 3.89 (2.07) 0.002
Phoneme Total errors (/24)b M (SD) 11.08 (4.89) 5.30 (3.89) 0.000
Rhyme Production errors (/6)b M (SD) 2.78 (1.68) 0.81 (1.15) 0.000
Time to completion in secondsa M (SD) 588.11 (133.88) 438.46 (97.82) 0.000
Overall performance (errors)b M (SD) 20.30 (8.67) 10.05 (5.65) 0.000
a Student’s t test
b Mann-Whitney test
DG, dyslexic group; CG, control group
Adults with dyslexia: how can they achieve academic success despite... 129

Table 3 Participant performance in measures of reading and writing

DG CG p

READING Complex syllables Percent errorsb M (SD) 9.47 (7.59) 1.96 (1.63) 0.000
Reading timeb M (SD) 183.32 (48.39) 133.42 (38.56) 0.000
Words and Words (/40)b M (SD) 0.82 (2.09) 0.14 (0.35) 0.98
pseudowords Pseudowords (/20)b M (SD) 5.28 (2.76) 1.71 (1.30) 0.000
(total errors)
WRITING Comprehensive Total errorsa M (SD) 16.47 (9.38) 2.67 (2.52) 0.000
Dictation
Senior Year Dictation Total errorsb M (SD) 20.42 (6.59) 7.71 (4.18) 0.000
Essay writing Total wordsb M (SD) 284.67 252.58 0.55
(216.74) (182.50)
Misspelled wordsb M (SD) 23.20 (19.66) 2.16 (5.71) 0.000
Percent misspelled wordsb M 9.12 (6.56) 0.63 (1.13) 0.000
(SD)
a Student’s t test
b Mann-Whitney test
DG, dyslexic group; CG, control group

participants when reading complex syllables and pseudowords, in addition to taking signifi-
cantly longer to complete these tasks. The only measure in which no significant group
differences were observed was accuracy for single word reading.
The analysis of writing tasks showed that individuals with dyslexia produced significantly more
errors of all types in the comprehensive spelling test. The total number of errors on this test was
compatible with the transition from 3rd (mean = 20.75) to 4th grade (mean = 12.85) according to
normative data for upper middle-class students. The mean number of errors made by the participants
with dyslexia in the high school senior dictation was 2.72 SD above the expected average recorded
for controls. The essay writing task did not reveal any group differences in the total number of words
written, though the number of misspelled words was significantly higher in individuals with dyslexia
than control participants.

Is the performance of highly educated individuals with dyslexia on reading

comprehension tasks (recall, literal, and inferential questions) like that of control
participants?

The data in Table 4 shows that participants with dyslexia did not differ from control participants in
the oral summary or comprehension questions (neither of which showed a ceiling effect, with
accuracy rates ranging from 50 to 70%). The assessment of strategy use did not reveal any
differences between the two groups: both appeared to identify the basic structure of the passage
and to use this information to their advantage. Measures of fluency showed that individuals with
dyslexia performed worse than control subjects in both reading speed and prosody.
130 Moojen S.M.P. et al.

Table 4 Participant performance in complex reading tasks

DG CG p
M (SD) M (SD)

Fluency Number of words read per minuteb 130.91(27.80) 172.40 0.000

(23.72)
Prosody Inadequatec 7 0 0.001
Insufficient 15 8
variationc
Adequatec 6 16
Reading comprehension Number of units 15.87(7.32) 12.03 0.04
Performance recalled (/63)a
Percent units recalleda 25.71 (7.50) 22.53 (8.51) 0.14
Reading speed Silent readinga 173.47(46.87) 130.70(45.52) 0.001
(seconds) Oral readinga 183.54(45.41) 140.13(19.13) 0.000
Questions Total correct 7.01(1.43) 6.69(1.14) 0.39
(/10)a
Inferential (/3)a 2.41 (0.64) 2.13(0.89) 0.20
Literal (/7)a 4.63(1.11) 4.56(0.79) 0.82
Percent correct 70 64 0.21
responses a
a Student’s t test
b Mann-Whitney test
c Chi-square test
DG, dyslexic group; CG, control group

Do highly educated individuals with dyslexia rely on text structure strategies to the same
extent as typical readers?

As shown in Table 5, qualitative and quantitative measures of the ability to identify the text
structure did not differ between groups. Furthermore, no differences were observed in the use
of propositions that explicitly connected ideas within the text.

Do individuals with dyslexia rely on the text structure as a compensatory strategy?

The association between the ability to identify the text structure, IQ, and reading speed was
examined using the Pearson correlations. Our results showed that the relationship between
these variables differed between the two groups. In participants with dyslexia (see Table 6), the
ability to identify the text structure was significantly related to recall (r = .65, p > 0.01),
comprehension questions (r = .48; p > 0.01), and overall performance (r = .71; p > 0.01).
Meanwhile, in the control group (see Table 6), sensitivity to the text structure was not
significantly related to any measures, despite a nearly significant correlation with recall ability
(r = .37, p = 0.06). No relationships between recall and comprehension questions were found
in either group, suggesting these tasks tap into different aspects of reading comprehension.
Interestingly, reading speed was not related to sensitivity to the text structure in individuals
with dyslexia. However, in the control group, longer reading times were positively associated

0
According to the procedure described by Diedenhofen and Musch (2015). Cocor: A comprehensive solution for
the statistical comparison of correlations, PLoS ONE, 10(4), DOI:10.1371.
Adults with dyslexia: how can they achieve academic success despite... 131

Table 5 Qualitative and quantitative measures of participants’ sensitivity to rhetorical structure of the text

DG CG p

Total direct coherence propositions (/24)a M (SD) 6.07 (4.50) 4.11 (3.25) 0.07
Percent coherent propositions 24 19 0.24
Total categories (/7)a M (SD) 3.78 (1.34) 3.19 (1.29) 0.10
Text structure patternsa Total unidentified 4 5 0.62
Total PS 4 7 0.25
Total PSR 20 13 0.10
a Student’s T-test. Note: result
PS, problem-solution; PSR, problem-solution-result; DG, dyslexic group; CG, control group

with the ability to identify the text structure. Additionally, verbal IQ was related to question-
naire performance in participants with dyslexia but not in the control group.
Besides that, the different correlation patterns observed in each group revealed that the relation-
ship between reading comprehension and the ability to identify the text structure was significantly
different between participants with dyslexia and control subjects (Z = 2.10, p = 0.031). Additionally,
sensitivity to the text structure predicted the three dependent measures over and above verbal IQ in
participants with dyslexia. Three-step fixed-order multiple regression analyses showed that, after
entering verbal IQ in a first step, structure sensitivity accounted for a significant portion of the
variance in questionnaire (ΔR2 = .14, F = 6.38, p < 0.01), recall (ΔR2 = .43, F = 9.64, p < 0.01), and
overall performance (ΔR2 = .50, F = 12.01, p < 0.01).
Note that reading speed of isolated words and pseudowords highly correlates to text, silent
and oral reading speed for the DG, suggesting that even when people with dyslexia face the
reading of a text, they adopt the same kind of reading that in facing simple words reading aloud
task. In the CG, reading word rate is less related to oral and silent reading suggesting that they
exhibit more flexibility in decoding than the adults on the DG.

Do adults with dyslexia report unhappier and more distressing experiences

throughout their life if compared with typical readers?

There were no differences identified between groups on the physical, social, and envi-
ronmental domains at the WHOQOL, but the groups differed in their emotional experi-
ences (Table 7). Similarly, people with dyslexia present more depressive symptoms
during the time of the study compared with the controls, as measured by BDI. On the
written report regarding their schooling history, dyslexics included more content relative
to their general difficulties, besides the reading and writing problems. They also men-
tioned the support they received to cope with these issues during their academic life. It
was shown that individuals with dyslexia reported higher frequency of depressive
symptoms both in school and adulthood.

1
According to the procedure described by Diedenhofen and Musch (2015). Cocor: A comprehensive solution for
the statistical comparison of correlations, PLoS ONE, 10(4), DOI:10.1371.
 132

Table 6 Intercorrelation between measures of participant performance

Variables 2 3 4 5 6 7

DG CG DG CG DG CG DG CG DG CG DG CG

1. Verbal IQ − 0.41** − 0.19 − 0.59** − 0.10 − 0.45* 0.06 0.25 − 0.01 0.47* 0.25 0.04 0.19
2. Reading speed (words and pseudowords) - - 0.81** 0.53** 0.79** 0.25 − 0.12 0.02 − 0.24 − 0.25 0.02 − 0.01
3. Silent reading speed - - - - 0.89** 0.32 0.09 0.41* − 0.19 − 0.32 0.20 0.28
4. Oral reading speed - - - - - - 0.02 0.22 − 0.36 0.13 0.02 0.05
5. Sensitivity to text structure - - - - - - - - 0.48* 0 0.65** 0.37
6. Comprehension questions - - - - - - - - - - 0.34 0.28
7. Information units recalled - - - - - - - - - - - -

DG, participants with dyslexia; CG, control group

Moojen S.M.P. et al.
Adults with dyslexia: how can they achieve academic success despite... 133

Table 7 Quality of life and emotional characteristics of the sample

DG CG p

WHOQOL Domain I, physicala M (SD) 15.13 16.17 0.13

domains (2.22) (2.81)
Domain II, psychologicala M (SD) 14.32 15.80 0.05
(2.96) (2.52)
Domain III, environmenta M (SD) 15.04 14.97 0.93
(3.28) (3.10)
Domain IV, social relationshipsa M (SD) 15.51 15.29 0.73
(2.18) (2.54)
Overall quality of life and general health 15.09 15.69 0.31
perceptions—general domaina M (SD) (2.01) (2.33)
BDI Total scoreb M (SD) 10.61 6.36 0.04
(8.50) (5.74)
Essay—content School sufferingc (%) 29.6 0 0.50
analysis Unspecified difficultiesc (%) 21.04 0 0.01
Reading and writing difficultiesc (%) 17.09 0 0.02
Diagnosis of dyslexiac (%) 25.0 0 0.007
Grade repetitionc (%) 35.7 17.9 0.18
Family supportc (%) 17.9 0 0.02
Professional helpc (%) 17.9 0 0.02
University entrancec (%) 50.0 60.7 0.24
Completing higher educationc (%) 28.6 46.4 0.10
a Student’s T-test
b Mann-Whitney test
c Chi-square test

Discussion

This study investigates two different issues. First, we investigated whether a sample of highly
educated dyslexic adults continues to display core deficits in reading and writing during
adulthood, supporting prior research. The second, and more important point, was to find out
whether these individuals compensate for the effects of persistent core deficits on reading
comprehension by examining the possible compensatory role of some of their cognitive
resources such as the structure strategy (Meyer, Brandt, & Bluth, 1980). In doing so, we
compared a particular sample of highly educated adults with dyslexia to a matched sample of
typical readers living both groups under optimal personal, cultural, and economic conditions.
Concerning the first issue and confirming prior research, the present results showed that
dyslexics exhibited impairments in phonological awareness (Boets et al., 2013; Callens, Tops,
& Brysbaert, 2012; Rueda Sánchez & Sánchez Miguel, 2011), pseudoword reading and
writing (Leinonen et al., 2001; Judge, Caravolas, & Knox, 2006), and reading fluency
(Mortimore & Crozier, 2006; Re, Tressoldi, Cornoldi, & Lucangeli, 2011; Shaywitz, 2006).
As expected (Suárez-Coalla & Cuetos, 2015), word reading accuracy was similar for both
groups. Globally, these findings expand to Brazilian Portuguese orthographic system, previous
results obtained from English, Dutch, Spanish, and Hebrew orthographies. Besides and given
the exceptional characteristics of our sample, regarding education status, intellectual level,
cultural, and socioeconomic status, the present findings may provide more robust evidence for
the persistent nature of dyslexia.
Adding to this, we found a negative correlation between verbal IQ and reading time in
dyslexics participants: the more IQ dyslexics have, the lesser time they need to read both the
134 Moojen S.M.P. et al.

text—silent and aloud—and isolated word tasks. This data supports existing theories regarding
the impact of general verbal ability (including oral comprehension) on word reading (Ransby
& Swanson, 2003) and literacy acquisition (García & Cain, 2014). As for the second issue, the
present results showed that adults with dyslexia performed similarly to control participants in
all measures of reading comprehension, including the oral recall and answers to open questions
(both literal and inferential). As for the speed of reading, silent and oral text reading was
slower in people with dyslexia than the control participants, suggesting that the former devoted
more time and effort during the reading. This result supports the conclusions of previous
studies (Nielsen et al., 2016; Parrila, Georgiou, & Corkett, 2007) and may help to explain why
other studies found that students with dyslexia showed poorer reading comprehension (Ransby
& Swanson, 2003; Simmons & Singleton, 2000) after considering the whole result. It seems
that the compensation for core deficits may only occur in the presence of specific conditions,
such as a long and successful educational experience.
Besides, both control groups, dyslexic participants were able to use the rhetorical structure of the
target text in organizing their oral recall after silent untimed reading. This means that they are highly
sensitive to text structure, a sophisticated skill (Meyer, Brandt, & Bluth, 1980; McNamara, 2007)
that can only be developed after a sustained and relatively successful schooling experience (Garcia,
Sánchez, Cain, & Montoya, 2019) as it is the case of the highly educated dyslexic sample of this
study.
Furthermore, data supports the idea that this skill could have played a compensatory role for the
dyslexic participants. Three results support this claim. First, the Pearson correlation values indicate a
clear relation between text structure sensitivity performance and both measures of reading compre-
hension in the dyslexic group, but not in the typical readers or control group. More specifically, the
magnitude of the correlations between structure sensitivity and recall, and questionnaire perfor-
mances was superior in the dyslexic group. Second, the impact of structure sensitivity was observed
in the two reading comprehension measures despite the small correlation coefficients observed
between them. A third result that reinforces the role of text structure sensitivity as a compensatory
strategy is that it predicted recall and questionnaire performances over and above verbal IQ. This
result is particularly interesting as it pertains to the questionnaire, given the size of the correlation
coefficient between these variables and verbal IQ.
The results suggest that individuals with dyslexia facing an academic and complex text can
compensate for their core deficits using three complementary resources, i.e., (1) a slow and
effortful reading; (2) making use of general verbal ability, as demonstrated by the influence of
this variable on reading speed and questionnaire performance; and (3) exploiting the rhetorical
text structure to process its content. As such, the main contribution of the present study is that it
shows the importance of identifying the text structure, a strategy that is specific to managing
academic text as a specific compensator resource for high educated dyslexics (Hebert, Bohaty,
Nelson, & Brown, 2016; Meyer, Brandt, Bluth, 1980).
Such global conclusion opens the issue in which extent this finding can be generalized to
the rest of reading academic demands. In the present study, we used a complex short academic
text and asked the participants to perform a recall task or to provide answers to different
questions. Under such conditions, our sample of adults with dyslexia compensated their core
deficits reaching a similar performance than typical readers of the control group. Undoubtedly,
many academic demands fit into such conditions, and these results would explain how the
dyslexic participants have been able to achieve its high educational level. However, it is easy to
imagine common academic task involving longer and more complex texts, and we need to
examine if, under such demanding conditions, the compensatory effect of each target skill
Adults with dyslexia: how can they achieve academic success despite... 135

(structure sensitivity in the present case) will disappear or not, opening the way for superior
performance of typical readers. Such a result would support the idea that the compensation of
the core deficits is not all or nothing and depends on the type of task and text considered.
In such a case, it could be predicted that even experiencing the valuable success document-
ed in this study by the dyslexic participants, the academic environment would be a challenge
for them. This is a prediction that seems compatible with the last results collected in this paper.
Conclusively, findings revealed in the socioemotional assessment show that adults
with dyslexia experience more adaptation difficulties than the control group. Though the
majority of the sample (75%) received emotional support for their problems, the present
findings indicate that participants with dyslexia may experience a higher number of
depressive symptoms and have a less favorable view of themselves than the control
group. This may be a consequence of the effort required to meet environmental demands
which require well-developed reading and writing skills. The awareness of the need for
excessive and persistent efforts in order to meet these demands may lead to frustration
and decreased self-esteem, increasing symptoms of depression and anticipatory anxiety
whenever these situations arise (Hen & Goroshit, 2014).
Our results are also in agreement with Hughes and Dawson (1995), which identifies a
pattern of failure at school, which continues to have long-lasting and profoundly negative
consequences. The present sample and statistical analysis do not have enough power to
establish cause and effect relations between depressive symptoms and the diagnosis of
dyslexia. However, the content registered at the report of schooling history shows more
information that relates to suffering and the need for family and professional support. The
sample studied here does not show a different emotional profile than the one described for
dyslexic adults from the literature (Ingesson, 2007; Nalavany & Carawan, 2012) and, most
probably, academic success does not come from the positive feelings towards the school or the
learning process. Compensatory mechanisms may take an emotional burden on participants
with dyslexia since previous investigations have also found a higher tendency to anxiety and
depression in adults with this condition (Leavett, Nash, & Snowling, 2014).

Limitations and further research questions

A first limitation is that indeed data supports the compensatory role of structure sensitivity, but
we need additional studies to clarify how this skill works to compensate for the core deficits.
Collecting eye-tracking data from people with dyslexia and typical readers seems a necessary
step to understand the mechanism for this compensatory process. In the same vein, we must
recognize that we should explain not only the people with dyslexia but also the typical reader’s
performances in these tasks, an issue we have not been able to solve sufficiently in this study.
In fact, in the control group, neither reading speed nor verbal IQ were associated with any
measures of reading comprehension, and more clearly against our frame, the sensitivity to text
structure barely correlated to oral recall. A possible explanation for these findings is that for
many control participants, other skills (perhaps the more basic ones) allow them to reach a
similar performance than the dyslexic participants, even though their performance was not
excellent (3.5 points over a maximum of 7 in structure sensitivity for instance or a 69.5% of
success in the questionnaire task).
Also, it is essential to note that a longitudinal study would clarify the role of the structure
sensitivity skill or rhetorical competence, since it is well established that these skills develop
slowly through elementary school (Garcia, Sánchez, Cain, & Montoya, 2019) supporting the
136 Moojen S.M.P. et al.

idea that it is necessary to have an extensive school experience to master it. Individuals with
dyslexia who acquire such skill earlier in school life would continue to practice this cognitive-
linguistic competence throughout the schooling years. As a consequence, they are better at text
comprehension and experience less struggle than students with dyslexia who are weaker in
these skills. Only a longitudinal study could disentangle these complex relationships that are
inherent to an accumulative and long development process.
Finally, another limitation of the study was the lack of a direct measure of socioeconomic status
for the participants. This prevented the investigation of any associations between SES, and other
variables thought to act as protective factors against academic difficulties. Therefore, given the
potential collinearity between SES, education, and access to resources that foster cognitive and
emotional development, it is crucial to investigate whether similar levels of academic success could
be observed in individuals with dyslexia from a lower socioeconomic background. Additionally,
variables such as morphological awareness, vocabulary, working memory, and oral language
comprehension were not investigated in the present study, though they have also been identified
as predictors of reading and writing abilities (Law, Wouters, & Ghesquière, 2015; Ransby &
Swanson, 2003). An additional limitation of the study refers to the age range for participants, and
small sample size, which may require caution in interpreting the results.

Acknowledgments This work would not have been possible without the cooperation of the following col-
leagues and their contributions to research planning and/or data collection: Dr. Jeanette Farina, Eriane Wainstein,
Marta Santolin, Rosália Saraiva, Roberta Munarski, and Dr. Jerusa Salles. We also extend our sincere thanks to
the team at the University of Salamanca who helped us with the discussion of our findings: Javier Rosales Pardo,
José Ricardo García Pérez, José Orrantia, and Mercedes Rueda. Finally yet importantly, we would like to express
our gratitude to our patients and to the participants in the control group for their support and for giving us their
time.

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Affiliations

Sônia Maria Pallaoro Moojen 1 & Hosana Alves Gonçalves 2 & Ana Bassôa 3 & Ana Luiza
Navas 4 & Graciela de Jou 5 & Emílio Sánchez Miguel 6
1
Hospital Moinhos de Vento de Porto Alegre (HMV), João Abbot Street, 333, Petrópolis district, Porto
Alegre, RS 90460150, Brazil
2
Conectare NeuroPsi, Conectare NeuroPsi - Atendimento, formação e conexões em neuropsicologia, Avenue
Getúlio Vargas, 1157, Porto Alegre, RS 90150-001, Brazil
3
Speech therapy clinic, Caju, 28/903, Porto Alegre, Brazil
4
Santa Casa de São Paulo, School of Medical Sciences, Cesário Mota Júnior Street, 61, 10th floor, São Paulo,
SP 01221-020, Brazil
5
Federal University of Rio Grande do Sul (UFRGS), Fernando Carneiro Street, 269, Porto Alegre, Brazil
6
University of Salamanca (USAL), Avenue de la Merced, 109, 37005 Salamanca, Spain
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