Reading after closed head injury in childhood: Effects on accuracy, fluency, and comprehension

Two studies of reading decoding, reading fluency, and reading comprehension after childhood head injury are reported. Study 1 tested whether age at head injury and the type of contusional brain damage were related to reading outcomes. Fifty-five children with head injuries were tested on measures of word decoding accuracy and reading comprehension. Children who sustained head injuries in the preschool years before basic word decoding skills are acquired or in the early primary grades when decoding skills are being taught, and children with bilateral or left-sided contusions were most at risk for difficulties in acquiring basic word decoding and reading comprehension skills. In particular, children injured before 61/2 years of age were most at risk for difficulties in acquiring reading decoding skills in comparison to children injured after this age. Study 2 tested whether deficits in processing speed after head injury are also found in reading. Forty-three head-injured children were matched with controls on a pair-by-pair basis for age, grade, and word decoding accuracy. The children with head injuries were slower at naming words, particularly those with less common orthographic patterns, although the groups did not differ on speeded naming of pronounceable nonwords. Reading fluency in the head-injured group was related to reading comprehension, suggesting that slow word-level processing has negative consequences for text comprehension in these individuals. The results are discussed with respect to how head injuries affect the development of skills yet to be acquired and the further acquisition of those skills that are in a rapid phase of development at time of injury. The results are also discussed with reference to models of how head injury affects speeded processing.