Executive Functioning in Every Day Life in Ecuatorian Adolescents with Developmental Dyslexia

Introduction: Deficits in executive functions (EF) have been well documented using tests of neuropsychological performance in children and adolescents with developmental dyslexia. However, the behavioral assessment of EFs in dyslexia is very scarce. Objective: The objective of this study was to examine the EF of adolescents with dyslexia, in comparison with adolescents with typical development. We used the BRIEF-A Behavior Rating Inventory of Executive Function in Adults (BRIEF-A). Method: 19 adolescents with dyslexia and 20 adolescents with normal development, participated, matched in age, sex and IQ. Parents and adolescents themselves completed the BRIEF-A. Results: The results show that both parents and adolescents with dyslexia consider that they have more problems of EF in daily life, especially in metacognitive processes (initiation, WM, planning, supervision of tasks and planning-organization). In addition, parents reported a lower severity of EF deficiencies than adolescents themselves when detecting a lower percentage of scores above the clinical cut-off point. Conclusions: Adolescents and their parents do not always agree in FE assessments. Consequently, information from both informants is essential to understand and treat children with developmental dyslexia. The results coincide with the FE deficits found with neuropsychological tests.


Introduction
Dyslexia is a specific learning disorder, manifested by unexpected difficulties in reading and spelling (APA, 2014;Lyon, Shaywitz, & Shaywitz, 2003).It is considered to be of neurobiological origin.In fact, during the last two decades a large number of neuroimaging studies have shown, both volumetric differences in gray and white matter, and less activation in the three major brain circuits related to reading fluency (frontal, temporoparietal and occipitotemporal) as well as the location of different genes involved in the transmission of dyslexia (see review in Soriano-Ferrer & Piedra-Martínez, 2017).In addition, different longitudinal studies conducted in orthographies with different degrees of transparency have shown that reading difficulties are relatively chronic and persistent in adolescence and adulthood (Bruck, 1992;Shaywitz, et al., 1999;Snowling, Muter, & Carroll, 2007;Swanson & Hsieh, 2009;Undheim, 2009;Wilson & Lesaux, 2001).
Research carried out over the last forty years has shown that adolescents and adults with reading disabilities have a large number of deficits in cognitive processes related to reading.Recently, these deficiencies have been interpreted as a deficit in the executive functioning, which is understood as a construct that involves a series of functions (e.g.inhibition, attention, decision making, planning, working memory, self-monitoring and cognitive set shifting, Brosnan et al., 2002;Diamond, 2013;Elliott, 2003;Rosselli, Matute, & Jurado, 2008;Stern & Morris, 2013).Such functions allow individuals to self-regulate, and direct their behavior towards the achievement of goals (Lyon & Krasnegor, 1996), especially on new behaviors and complex tasks (Wittlin, 2010).Different studies have shown a lack of executive functioning in children and adults with reading disabilities (Altemeier, Abbott, & Berninger, 2008;Booth, Boyle, & Kelly, 2010;Reiter, Tucha, & Lange, 2005;Varvara, Varuzza, Sorrentino, Vicari, & Menghini, 2014).In particular, the meta-analysis of 48 studies conducted by Booth et al. (2010) stresses that reading seems to depend more on inhibition, working memory, processing speed, change of attention and self-control.
However, research on executive functioning through neuropsychological per- functions from two sources of information (self-report and observers) in Spanish-speaking adolescents with dyslexia.Thus, the present study aims to: a) examine the profile of executive functioning in Spanish-speaking adolescents with reading disabilities based on their own assessments and those made by their parents as observers; b) compare the differential scores (calculated from the observer's assessments and the self-report itself) between adolescents with reading disabilities and those with typical development.

Participants
The sample consisted of 39 Ecuadorian adolescents, with and without reading disabilities, selected from the last year of secondary school.The selection of the sample was made through the psycho-educational teams of three cities of Ecuador (Azogues, Cuenca and Guayaquil).School psychologists informed us about possible candidates with reading difficulties for the study.We contacted them to get their participation in the study.Participants were asked to collaborate in the study and signed the informed consent.Students were informed about the objective of the study and that they could withdraw from it the moment they felt like doing so.Students with difficulties were asked to contact with a friend of their class without reading difficulties who could collaborate in the study as a subject of the study in the control group.In this way it was controlled that the two groups belonged to the same social stratum.
The control group consisted of 20 subjects, 8 women and 12 men with an average age of 17 years and a standard deviation of .59.All of them with intelligence within normal and with adequate reading skills.In all cases, those participants who had a history of low academic performance and/or with educational needs, associated with some type of disability, were excluded from the study.
The group with reading disabilities was composed of 19 participants, 14 men and 5 women, with an average age of 16.85 and a standard deviation of .52.The students were from three cities (Azogues, Cuenca and Guayaquil).Thirteen of them already had a previous diagnosis of developmental dyslexia.The criteria in the selection of the group of participants with reading disabilities followed the diagnostic guidelines of the DSM-5 (APA, 2014).That is, participants had to show the following: 1) Non-verbal intelligence of 80 or more by means of the general capacity test (Factor "G") (Cattell & Cattell, 1990); 2) significantly low reading performance in the individual application test, Battery of Evaluation of Reading Processes (PROLEC-SE, Ramos & Cuetos, 2003).Specifically, those subjects who had a performance equal or lower than the 25th percentile (Pc 25) in the subtest of word reading and/or reading pseudo-words were selected; 3) exclusion criteria.From the analysis of the personal and academic history of the subjects, those participants with a history of brain injuries or neurological prob-

Evaluation Instruments
Intelligence: The "g" Factor Test of Cattell & Cattell was used.Scale 3 (1990) for adults, which consists of four sub-tests: series, classification, matrixes and conditions, which involve cognitive operations of identification, perceptual similarities, serialization, classification, matrixes and comparisons and involve different perceptual contents in order to prevent some perceptual differences from influencing the results when measuring intelligence.This test has a reliability of .86.
Reading performance: as indicators of reading accuracy, the lexical processes subtest, word reading and pseudo-word reading of the PROLEC-SE secondary reading evaluation battery (Ramos & Cuetos, 2003) were used.This test requires the correct identification of 40 words and 40 pseudo-words with different length, frequency, and graphemic complexity (CCV, CVV, CVC, CCVC, CVVC, VC).
The successes and the time used in the reading were counted.In order to interpret more clearly the reading behavior of the participating groups, word reading and pseudo-word reading indexes were calculated, dividing the hits in each of the scales by the time spent reading them, and multiplying the results by 100.
The BRIEF-A, Behavior Rating Inventory of ExecutiveFunction (Roth et al., 2005) was used.The BRIEF-A is a standardized questionnaire that assesses the executive or self-regulation functions in their daily environment.Two formats were used: a self-report and an informant report who is familiar with the daily functioning of the individual.The BRIEF-A consists of 75 items that generate 9  The BRIEF-A is an instrument with adequate psychometric properties in terms of test-retest reliability (correlations ranging from .82 to .94) and internal consistency (α coefficients ranging from .85 to .98).In addition, the support for the convergent and discriminant validity of the BRIEF-A has been reported by (Roth et al., 2005).In this study, the two versions, the self-report and the observer-report, were applied, and both have received positive evaluations in other investigations (for example, Pizzitola, 2002).All the evaluations were carried out in an isolated room of noises, designated only to investigation, at Universidad del Azuay in a session of an hour and a half.The parents filled in the questionnaire of the observer from BRIEF-A.To carry out the evaluation of the adolescents, the parents gave the written consent, in which they were informed of the confidentiality of the data, of the participation and the voluntary withdrawal of the study, and the objectives of the investigation according to the ethical parameters on research with human beings declared in Helsinki.

Results
After verifying that the data fulfilled the criterion of statistical normality, applying the Kolmogorov-Smirnov test, a multivariate analysis of variance (MANOVA) was performed with the group of origin as a grouping factor.After, an analysis of variance (ANOVA) for comparison between groups was carried out.For interpretation purposes, the Bonferroni correction (.05/18 = .002)was applied to determine the significance levels.In addition, the size of the effect was provided by the eta squared (η 2 ), considering values between .01 and .10 as a small size effect, between .10 and .30as the median effect and values greater than .30as large effects.
Comparison between groups in the self-report questionnaires and the

Percentages of adolescents that exceed the clinical cut-off
The percentages of adolescents who obtained scores in the different BRIEF-A subscales and indexes that exceeded T ≥ 65, which were considered clinically significant, were calculated.As can be seen in Figure 1 and Figure 2, the number of adolescents who obtained scores T ≥ 65 and that can be considered clinically significant is greater in the group with dyslexia, both in the self-report questionnaire and in the observer's questionnaire.BRIEF-A, which in this case were the parents.In general, it is the adolescents with dyslexia themselves who showed the greatest number of difficulties in executive functions that their parents value.
Specifically, in the self-report scale the number of clinical cases was higher in the subscales that make up the Metacognitive Index (see Figure 1): 1 (5.27%) in Initiative; 3 (15.8%) in working memory; 15 (79%) in Plan/ Organize; 12 (63.16) in Task Monitor and 1 (5.27%) in Organization of Materials.In the case of the subscales of the Index of Behavioral Regulation, the subjects above the clinical cut-off point are much lower: 1 (5.27%) for the subscales (Inhibit, Emotional Control and Self-Monitor) and 2 (10.53%) for the subscale (Shift).
In the scale of the informant, more clinical cases were also found in the dyslexia group, although notoriously less than those reported by adolescents with dyslexia, especially in the subscales of the Metacognitive index (see Figure 2): 5 (26.32%) in Plan/Organize; 3 (15.8%) in Task Monitor; and 2 (10.53%) in Initiate, Working Memory and Organization of Materials.In relation to the subscales of the Index of Behavioral Regulation, the cases that exceeded the clinical cut-off were much lower: 2 (10.53%) in Shift and 1 (5.27%) in Self-Monitor.
Differential scores between self-perceptions and the perceptions of the observer Figure 3 shows the average scores of the differential scores between the adolescents with dyslexia and the normo-reader adolescents, calculated by subtracting the T scores of the observer (the parents) from the T scores of the self-reports.Positive differential scores indicated that parents (observers) expressed more executive difficulties than adolescents self-perceive, while negative scores indicated that adolescents were the ones who perceived themselves with the most problems in executive functioning in regard to their parents' evaluations.
In general, adolescents perceive themselves with more difficulties in almost all domains of executive functioning regarding the evaluations made by their parents.The exception was Self-Monitor, where parents made the most negative   assessments of their abilities.However, in the other domains of executive functioning, adolescents with dyslexia were the ones who made the most negative evaluations of themselves, especially in the skills of Plan/Organize and Task Monitor, in comparison to the normo-reader adolescents.In spite of the differ- ences, they do not they reach statistical significance.

Discussion
The aim of this research was to examine the executive functions in adolescents with dyslexia and to compare them to adolescents with typical development using a scale of evaluation of executive functioning in daily life.
Adolescents with dyslexia perceive themselves and are perceived by their family with more problems in the executive functioning in their daily activities, Although to a lesser extent, they also experience difficulties in some of the subscales of the behavioral regulation index (Inhibit and Shift).Thus, adolescents perceive themselves and are perceived by their parents with serious difficulties to face and resolve everyday situations of life.That is, they seem to maintain generalized deficits in executive functions of daily life similar to the few studies conducted with behavioral scales (e.g.Locascio et al., 2010;Schöfl et al., 2014;Smith-Spark et al., 2016;Spicer, 2015).Zelazo & Müller (2002) differentiated between cold and hot executive functions; cold EFs tend to be used in abstract, decontextualized tasks, while hot EF are involved when tasks have a motivational meaning for the individual and in its control.The two types of Executive Functions are used to address real-world problems (e.g.Zelazo, 2015).Giancola, Godlaski, & Roth (2012) associated the metacognition index with cold EF and the regulation index of the behavior with warm EF.From this perspective, our results suggest more difficulties in cold EF in adolescents with dyslexia, while warm EF are less altered.
Our data, although not statistically significant, point out that adolescents with dyslexia make more negative descriptions of themselves than their parents do of their executive functioning.This aspect is also supported by the large number of adolescents, whose self-reports exceed the cut-off points of clinical significance, which reach between 60% -80% of the cases in Plan/Organize and Task Monitor.This aspect of our data is new for two reasons.Thus, these data suggest that adolescents with dyslexia under estimate their own abilities; that is, they do not show the positive illusory bias, which has been so consistently described in children and adolescents with Attention Deficit Hyperactivity Disorder, who tend to be overrated in their abilities (e.g.Stewart, Tan, Delgaty, Gonzales, & Bunner, 2017).
Finally, it is important to refer to the limitations of our study.First, ratings scales have limitations, since they may be subject to informants' biases, since their estimates of executive functions could be influenced by prejudices and previous experiences.Future studies should explore the source of the discrepancies by using an independent evaluator who would observe on a day-to-day basis.
Another limitation is the BRIEF-A scale itself, which assesses many executive functions globally, but does not perform a thorough analysis of any of them.
However, the use of rating scales is recommended as part of a thorough psychological exploration of reading difficulties, since they can be useful in the planning and evaluation of treatment (Roth et al., 2005).In fact, our results highlight, both with the adolescents "own evaluations and with their parents" ratings, that a relatively large percentage of Spanish-speaking adolescents with reading difficulties manifest a large number of executive dysfunctions, especially in metacognitive processes (initiation, WM, planning, supervision of tasks and planning-organization).They are also important for intervention, since difficulties in  & Zhang, 2013;Shiran & Breznitz, 2011;Tilanus, Segers, & Verhoeven, 2016;Yang, Peng, Zhang, Zheng, & Mo, 2017).
How to cite this paper: Soriano-Ferrer, M., Piedra-Martínez, E., & Arteaga, M. (2018).Executive Functioning in Every Day Life in Ecuatorian Adolescents with Deve-M.Soriano-Ferrer et al.DOI: 10.4236/psych.2018.950661051 Psychology in a flexible manner according to a situation (e.g."I have trouble changing from one activity or task to another", "I am bothered by having to deal with changes").Emotional Control scale (10 items) measure the capacity to modulate emotional responses (e.g."I have ungry outbursts", "My mood chances frequently").Self-Monitor scale (6 items) assesses the ability to monitor one's own behaviors and the effects they have on people (e.g."I talk at the wrong time ", "People say that I don`t think before acting").The Metacognitive Index represents the ability to solve for future-oriented problems in an organized, planned, systematic way, using working memory.The Initiate scale (8 items) reflects an individual's ability to begin a task or activity and to generate ideas, responses, or problem-solving strategies (e.g."I lie around the house a lot", "I have trouble getting started on tasks").The Working Memory scale (8 items) measures the capacity to hold information in memory in an active state for completing a task or production of a response (e.g."I forget what I am doing in the middle of things", "I have a short attention span").The Plan/Organize scale (10 items) measures an individual's ability to manage current and future task demands (e.g."I have trouble prioritizing activities", "I have problems organizing activities").The Task Monitor scale (6 items) reflects the capacity to track success or failure in solving a problem, and to identify and correct mistakes during behaviors (e.g."I make careless errors when completing task", "I have problems completing my work").The Organization of Materials scale (8 Items) provides information on the orderliness of work, home, and other personal spaces (e.g."I am disorganized", "I leave my room or home a mess").Additionally, the questionnaire provides a global composite index (GEC) of all clinical subscales.The higher scores of the BRIEF-A indicate greater deterioration of executive functioning.The raw scores can be transformed (T-score) based on standardized population samples.The scores of ≥65 were considered as clinically significant.

Figure 1 .
Figure 1.Number of cases above the clinical cut-off (T ≥ 65) for the Self-Report form (BRIEF-A).

Figure 2 .
Figure 2. Number of cases above the clinical cut-off (T ≥ 65) for Informant form (BRIEF-A).

Figure 3 .
Figure 3. Mean of the differential scores in the BRIEF-A subscales.
normo-reader peers, especially in the subscales of the metacognitive index (Initiate, Working Memory, Plan/Organize, Organization of Materials).
deficiencies, school absenteeism, intellectual disability, as indicated by the DSM-5 (APA, 2014) were also excluded.Table1shows the descriptive data of the participants.

Table 1 .
Descriptive data for both groups.Psychology clinical subscales, which are grouped into two indexes: behavioral regulation index (BRI) composed of 4 subscales (Inhibit, Shift, Emotional Control, and Self-Monitor) and the metacognitive index (MI) composed of 5 subscales (Initiate, Working Memory, Plan/Organize, Task Monitor, and Organization of Materials).The Behavioral Regulation Index represents the ability to control and regulate emotional response, shift cognitive set and modulate behavior.The Inhibit scale (10 items) assesses the ability to suppress impulses and to stop one's own behavior at the appropriate time (e.g."I tap my fingers or bounce my legs", "I am impulsive").The Shift scale (6 items) assesses the ability to adjust behavior

Table 2 .
Descriptive data of the groups on all the scales and indices of the BRIEF-A for self-report and informant forms.
M. Soriano-Ferrer et al.DOI: 10.4236/psych.2018.950661061 Psychology executive functioning could be addressed.In fact, some works have already begun to demonstrate the effectiveness of cognitive training in FE, especially working memory (e.g.Horowitz-Kraus & Breznitz, 2009; Luo, Wang, Wu, Zhu,