Turid Helland: RI-5 (English)
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RI-5: Questions and answers
1. What does RI-5 stand for? RI-5 stands for Risk-Index, aiming at five-year old children,
targeting risk of developmental dyslexia in school age. It is based on a questionnaire made
for the population-based longitudinal study “Speak up!” to be filled out by parents and
pre-school teachers of children who in 2003 were five years old. The children in the study
have been followed for ten years, and the questionnaire has proved to be a good predictor
of developmental dyslexia (for more information on the project, see
http://www.uib.no/en/project/speakup). The data base of the RI-5 is from the start of the
“Speak-up!” project in 2003 and from data collected on five-year old pre-school children
in 2013. See Table 1 for group comparisons.
2. Can dyslexia be detected ahead of school age? We know that dyslexia is a congenial
condition which may affect literacy development. We also know that dyslexia cannot be
explained by one single factor, but rather from the combination of several benchmark
factors, which can be assessed at a pre-literacy stage. These factors are innate and cannot
be explained by environmental factors. The exact effect of the interaction between these
factors cannot fully be seen at a pre-literacy stage, but we know that early intervention
can ameliorate the process of learning to read and write.
3. What is the connection between all the questions in the RI-5 and dyslexia? The
questions in RI-5 target evidence from much research on factors related to the
development of dyslexia. Most prominent factors are specific language impairment (SLI)
and familial occurrence. But research point to problems with i.e. visual memory, motor
skills and laterality (right/left confusion). Questions concerning health can indirectly
relate to the larger “dyslexia” picture. Different combinations of assets and deficits within
these factors may constitute risk factors of dyslexia. This also means that dyslexia
expresses itself differently from person to person, however with reading and writing
problems as a core factor.
4. Why do both parents and pre-school teachers have to fill out the RI-5? Parents and
teachers see the child from different viewpoints. Parents are familiar with the child’s
development from birth on and can also convey information on language related
problems in close biological family. The teacher gets to know the child relatively early,
but does not have the same insight into its infancy and heredity. The teacher observes the
child together with other children in the pre-school, and has a professional eye on the
child’s development. Through the collapsed information from parents and pre-school
teacher we get a valuable picture of early risk factors of dyslexia in the child.
5. How can we understand the RI-5 score? The RI-5 score is based on a mean score
calculated from the responses given by parents and teachers. A low RI-5 indicates no or
minor risks of developmental dyslexia, while a high score indicates at-risk. The scale
ranges from 0 to 100. A score of 0 means no risk sign, while a score of 100 indicates
major problems not specific to dyslexia only. This means that a score above 50 points to
more general rather than specific problems. Typically, dyslexia is a subtle impairment
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Turid Helland: RI-5 (English)
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7.
8.
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and the soft signs are often difficult to observe. The distribution of scores of the collapsed
sample is shown in Figure 1, and the at-risk scores are seen to the right on the x-axis.
Different cut-off scores for boys and girls. When the “Speak-up!” project started in
2003, the general understanding was that more boys than girls developed dyslexia.
However, both clinical experience and research indicate that this is not necessarily the
case, since the development of dyslexia seems to differ between boys and to girls. In
general the symptoms appear earlier in boys, and more boys than girls are referred for
clinical assessments. Girls more often have soft signs that are difficult to detect, and they
are often cleverer at hiding their problems. Thus, that the calculated cut-off score was
lower for girls than for boys, and that as many girls as boys developed dyslexia, came as
no surprise (see Figure 2).
Can we trust the RI-5? In the “Speak-up!” project 85% of the children who developed
dyslexia were true positives (i.e. they were defined as at-risk when they were five years
old), and 15% were false negatives (i.e. they were not defined as at-risk when they were
five years old). This means that the RI-5 proved to be a valid, but not perfect, predictor of
dyslexia. In general it is not expected that a tool like the RI-5 will have a perfect hit.
Usually not all children defined as at-risk will develop the targeted impairment, as in this
case dyslexia.
It may be useful to say a little more about what led to no detection through the RI-5
questionnaire. In some cases the familial occurrence was not known or ignored. However,
through the project the family members started to talk about language problems and
dyslexia, and gradually close family members revealed their literacy problems. Had this
been apparent when the parents filled out the questionnaire, their children would most
probably have been defined as at-risk. Contrary to this example, no at-risk factors were
found in a few individuals who later developed dyslexia. These two examples illustrate
that even if the predictive value of RI-5 is good, there is a chance that important
background information may appear when the child gets older, and that there are cases
we do not understand or can explain with our present knowledge.
In spite of these examples, it is reasonable to characterize the predictive value of RI-5 as
good. The basis for this statement lies in the data that emerged during the ten years the
children in the “Speak-up!” project were followed. The RI-5 score correlated
significantly with scores of reading and spelling when the children in the project were 8
years old (3rd grade), and with reading and writing scores in both L1 (Norwegian) and L2
(English) when they were 11 years old (Helland, Plante, & Hugdahl, 2011). Unpublished
data showed that the RI-5 scores correlated significantly with literacy grades from the
participant’s 10th year of schooling. This means that the risk factors constituting the Risk
Index when the children were 5 years old were in sum valid indicators of later literacy
development.
Who can use the RI-5? RI-5 should be administered and interpreted by professionals
who have specialized in child language development and literacy problems. The
questionnaire is to be filled out by both parents and the pre-school teacher who knows the
child best. Since many parents of the targeted children may have reading and writing
problems themselves, the language in the questionnaire is kept simple and easy to read,
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and responses are to be ticked out in boxes. When the Risk Index is calculated by the
professional, a platform for how to proceed is established.
9. What is the next step if the score indicates at-risk? If the child gets a score within the
defined at-risk zone, he or she should be referred for individual assessment based on what
we at present know about early signs of dyslexia (for readers of Scandinavian languages,
see Helland 2012, Chapter 3 on specific language impairment, and Chapter 9 on
assessment of language and dyslexia). If the testing shows no signs of impairment, there
is no reason for further assessments. But if there are signs of impairment, the assessment
should be followed up by evidence based training (see Helland, 2012, Chapter 10 on
intervention methods and educational rights).
10. How is the risk zone defined? If we follow the results from the “Speak-up!” project, the
cut off-score for boys is 17 points, and for girls 9,7 points. Figure 2 shows the score
distribution by gender from the RI-data base of 190 five-year old children. The cut-off
scores should not be seen as absolute, and one should be especially aware of the
borderline scores.
11. What about children with another first language than Norwegian? In our database 12
children had another first language than Norwegian. They all came from the 2013 sample
with 81 participants. As can be seen from Table 1a) there were no statistical differences
between the mean scores of the L1 (Norwegian as first language) and L2 (Norwegian as
second language). Only one of the L2 children belonged to the at-risk group. This
indicates that the RI-5 is independent of the child’s language, but needs further research
on a larger sample.
Table 1. RI-5 scores by groups
Group
Group
SD
a)
RI-5
2003
N = 109
9.96
RI-5
M
N = 103
12.06
RI-5
Typical
N = 148
5.74
RI-5
L1
N = 69
9.72
b)
c)
d)
SD
t-value
df
p
Cohen’s d
10.07
2013
N = 81
9.28
9.83
0.466
188
0.642
0.07
11.20
F
N = 87
6.84
7.34
3.72
188
0.000
0.55
4.12
At-risk
N = 42
23.50
11.99
-15.21
188
0.000
-1.98
10.21
L2
N = 12
6.71
7.10
0.979
79
0.331
0.34
Notes. Group comparisons on the basis of a) samples 2003 and 2013; b) gender; c) at-risk; d)
Norwegian as first language (L1) and other language than Norwegian as first language (L2).
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Turid Helland: RI-5 (English)
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Figure 1. Distribution of RI-5 scores from 190 five year old children
Figure 2. RI-5 scores by gender (M: n = 87 and F: n= 51)
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Turid Helland: RI-5 (English)
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Next steps
 Individual testing. Formal testing should be based on evidence and should describe both
assets and deficits of the child’s language competence and the cognitive skills associated
with language and literacy development (see Helland, 2012, pp 49-50 and Chapter 9 on
assessment of language and dyslexia). As a conclusion to the assessment, suitable,
evidence based training methods should be implemented (see Helland, 2012, Chapter 10
on intervention and educational rights).
 Training. In the “Speak-up” project the children received intensive, databased training
when they were 5, 6 and 7 years old. The training was individual; it lasted daily for two
months each year, and comprised 20-minutes lessons together with especially trained
teachers. The selection criteria of the programs were evidence based training effects
(Helland, Tjus, Hovden, Ofte, & Heimann, 2011). After each lesson the teacher made
notes on the child’s motivation and involvement. From this information it was obvious
that the children enjoyed the training (Engelsvold Sværi, Strandenæs Andersen, &
Helland, 2015).
 Training effects. It is important, but not fulfilling, to evaluate training effects solely on
the background of motivation. Also effects from literacy tests must be evaluated. In the
“Speak-up!” project tests of reading and writing from 3rd, 6th and 10th grades showed that
although the dyslexic children scored lower than controls, they all had acceptable scores
and no one had fallen behind. These results may be explained in several ways, and one
explanation is probably the basic effect of early training. Research point to pre-school
deficits as to neurocognitive and biological benchmarks in dyslexia (Clark et al., 2014;
Helland & Morken, 2014; Myers et al., 2014; Specht et al., 2009), but research also point
to the importance of early training, taking advantage of the brain plasticity of the young
child.
References
Clark, K. A., Helland, T., Specht, K., Narr, K. L., Manis, F. R., Toga, A. W., & Hugdahl, K.
(2014). Neuroanatomical precursors of dyslexia identified from pre-reading through to
age 11. Brain. doi:10.1093/brain/awu229
Engelsvold Sværi, V., Strandenæs Andersen, I., & Helland, T. (2015). Førskolebarn i
risikosonen for å utvikle dysleksi og databasert trening. En motivasjonsstudie. Norsk
tidsskrift for logopedi, 1.
Helland, T., & Morken, F. (2014). Neurocognitive Development in Dyslexia From the The
Bergen Longitudinal Dyslexia Study. Paper presented at the Society for the
Neurobiology og Language. Konferanse retrieved from
Helland, T., Plante, E., & Hugdahl, K. (2011). Predicting Dyslexia at Age 11 from a Risk
Index Questionnaire at Age 5. Dyslexia, 17(3), 207-226. doi:10.1002/dys.432
Helland, T., Tjus, T., Hovden, M., Ofte, S., & Heimann, M. (2011). Effects of Bottom-Up and
Top-Down Intervention Principles in Emergent Literacy in Children at Risk of
Developmental Dyslexia: A Longitudinal Study. Journal of Learning Disabilities,
44(2), 105-122. doi:10.1177/0022219410391188
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Myers, C. A., Vandermosten, M., Farris, E. A., Hancock, R., Gimenez, P., Black, J. M., . . .
Hoeft, F. (2014). White Matter Morphometric Changes Uniquely Predict Children’s
Reading Acquisition. Psychological science, 25(10), 1870-1883.
doi:10.1177/0956797614544511
Specht, K., Hugdahl, K., Ofte, S. H., Nygård, M., Bjørnerud, A., Plante, E., & Helland, T.
(2009). Brain activation reveals at-risk for dyslexia in 6-year old children.
Scandinavian Journal of Psychology, 50, 79-91. doi:DOI: 10.1111/j.14679450.2008.00688.x
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