"E-readers are more effective for some readers with dyslexia than paper," BBC News reports. The story comes from a study of just over 100 students with dyslexia. Researchers compared the students' reading comprehension and speed using an Apple iPod Touch and the same text on paper. The test on the iPod Touch was formatted to display only a few words per line.

In some students, reading speed and comprehension was better when using the device compared with reading longer lines of text on paper. But the results of this small study are more mixed than reports suggest. Only students with very poor visual attention benefited from using the e-readers.

Visual attention is the ability to process multiple visual elements, such as the words in a sentence or the letters in a word, simultaneously. It is thought that in some people, difficulties with reading spring from problems with this ability.

As the researchers point out, it may be the device's ability to display text in large font and short lines, rather than the device itself, that benefits some students.

If you are affected by dyslexia and you have access to an e-reader, you could experiment with the settings of your e-reader to see if it makes reading easier.

Where did the story come from?

The study was carried out by researchers from the Harvard-Smithsonian Center for Astrophysics in the US and other institutions. It was funded by the National Science Foundation and the Smithsonian's Youth Access Grant programme.

The study was published in the peer-reviewed journal PLoS ONE. This is an open access journal, so the article is free to read online or download.

BBC News' coverage was generally accurate and included a comment from a dyslexia expert in the UK, who highlighted the fact that, aside from e-readers, there are a range of assistive technologies available for people with dyslexia.

What kind of research was this?

This was an experimental study that tested whether the reading comprehension and speed of people with dyslexia would be greater using a handheld e-reader.

In the experiment, the e-readers were customised to display only a few words per line; the paper equivalent had the normal amount of words per line.

The study used a randomised crossover design in which participants served as their own controls. In other words, all participants used both methods of reading and the results were compared.

Dyslexia is characterised by difficulties in learning to read and is one of the most common learning difficulties. People with dyslexia are thought to have difficulties "decoding" words. They have particular difficulty identifying "phonemes", which are the basic sounds of speech – for example, the "s" sound in "sat" is a phoneme.

This makes it difficult for people with dyslexia to link the sound to the letter for that sound, or blend sounds into words, and they often find it hard to recognise words or sound words out. They may also have problems with verbal memory and verbal processing speed.

The researchers say that in recent years, studies have suggested that people with dyslexia may have problems with visual attention and how they control their eye movements when reading. This has led to the suggestion that adjusting how text is displayed may be helpful. In particular, a reading method where each line of text spans only a few words has been proposed.

While in previous decades this would be impracticable using printed material, it is now possible through a small-screen handheld device such as a smartphone or tablet computer using large fonts.

What did the research involve?

The researchers recruited 103 participants (64 male and 39 female) with a history of dyslexia. They were all American high school students at a school for people with language disabilities.

Researchers evaluated the students' current reading skills using a number of standard tests, including phoneme decoding, sight word reading and reading speed. They also tested their visual attention spans.

The students were divided at random into four groups. Each group was given two sets of text to read from a standard reading test used in schools to assess two different reading levels. One test was read on paper, the other on a third-generation Apple iPod Touch.

The test contained 12 reading passages that increased in length and complexity as they went on. Two groups started reading from paper, and two started with the iPod Touch.

After completing the first set of reading speed and comprehension tests, they completed a second set using the alternative reading method (either iPod Touch or paper). To test their comprehension of the text, all students answered 48 multiple choice questions on paper about the passages they had read. Researchers also measured reading speed (in words per second) and visual attention span using specialist software.

In the paper version, text was printed on normal white paper using a 14 point Times font with one-inch margins and single line spacing. Each line of text held an average of about 14 words.

On the iPod Touch, text was displayed in Times New Roman font at a setting of 42 point. The lines were short, displaying an average of about three to four words per line. The background was set to black with grey text. Text was manually scrolled as a continuous stream. The researchers call this method span limited tactile reinforcement (SLTR).

The researchers took steps to remove the potential for bias due to novelty – that is, the possibility that students would do better when reading on the iPod Touch as it was new and more interesting to them than reading from paper.

To do this, they got the students to practise reading using the SLTR method on the iPod for a minimum of 300 minutes prior to testing.

The students chose practise materials from among a number of popular age-appropriate e-books offered to them and answered questions about the text.

The researchers analysed whether reading comprehension and reading speed differed between those using the iPod Touch and paper, and whether this was influenced by their phoneme decoding, sight word reading or visual attention spans.

What were the basic results?

The researchers found that use of the device significantly improved reading speed and comprehension, when compared with reading text on paper, for specific subsets of the students:

those who had poorer visual attention spans – about a third of all students – were able to comprehend better when reading on the iPod Touch than on paper

those who had poor phoneme decoding skills – almost half – read faster using the iPod Touch than reading on paper

However:

those with better visual attention spans did better at comprehension while reading on paper

those who were better at phoneme decoding read faster on paper than on the iPod Touch

How did the researchers interpret the results?

The researchers say that reading using short lines displayed via small handheld e-readers improves comprehension and reading speed in some readers with dyslexia.

They conclude that the method is beneficial for substantial numbers of students when used as an adjunct to more traditional reading interventions and support.

They suggest that the use of short lines may guide attention to individual words and stop multiple words on a line "competing" for attention, an effect known as "crowding".

Conclusion

This study seems to be good news for some dyslexia students, although the results were more mixed than a first look at the paper suggests. While those students who had more difficulties with visual attention span and decoding unfamiliar words had better comprehension or reading speed on the iPod Touch, the remaining students did better with paper.

There are also some limitations to the study:

as the authors point out, their sample comprised students who had been enrolled in a special school focusing on intensive reading intervention, so it is uncertain if the results would apply to dyslexic children in mainstream education

the study was relatively small, and confidence in the results would be increased if future studies also find similar results in larger groups of people with dyslexia

although the researchers did try to remove any "novelty" effect of the e-readers, they may still have been more interesting than paper formats, which the students would have been struggling with for many years

Importantly, the researchers note that it is the short line length that they think is having the effect, rather than the e-reader itself. Future studies could test this by comparing paper formats with fewer words per line with paper formats with longer lines of text.

Nevertheless, the large number of options in size and spacing that can be created using e-readers certainly make them a more flexible reading option, and this study suggests that they may be worth exploring for students with dyslexia.

Analysis by Bazian

Edited by NHS Website