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 he ad 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 h ead injuries in the preschool years before basic word decoding skills are a cquired or in the early primary grades when decoding skills are being taugh t, and children with bilateral or left-sided contusions were most at risk f or difficulties in acquiring basic word decoding and reading comprehension skills. In particular, children injured before 6 1/2 years of age were most at risk for difficulties in acquiring reading decoding skills in compariso n to children injured after this age. Study 2 tested whether deficits in pr ocessing speed after head injury are also found in reading. Forty-three hea d-injured children were matched with controls on a pair-by-pair basis for a ge, grade, and word decoding accuracy. The children with head injuries were slower at naming words, particularly those with less common orthographic p atterns, although the groups did not differ on speeded naming of pronouncea ble nonwords. Reading fluency in the head-injured group was related to read ing comprehension, suggesting that slow word-level processing has negative consequences for text comprehension in these individuals. The results are d iscussed 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 discu ssed with reference to models of how head injury affects speeded processing .