The relationship between children's reading ability and emotional health

Around 16% of children have reading skills that fall below the average range for their age, and 5% of children have significant reading difficulties. It is well understood that poor reading increases a child's risk of school failure. However, we are only just beginning to understand how poor reading may affect a child's emotional health. The overarching goal of this thesis was to improve our understanding of the association between poor reading and emotional health. To this end, this thesis addressed five specific aims. The first was to determine if there is a reliable association between poor reading and anxiety. We conducted a systematic review and meta-analysis investigating associations between poor reading and internalising problems, anxiety, and depression. We found a statistically reliable and moderate association between poor reading and internalising problems, which appeared to be driven by anxiety. Our second aim was to determine whether certain types of poor reading are associated with certain types of anxiety. We conducted a profiling study with groups of children with different reading and anxiety profiles, and compared the groups on different types of poor reading and anxiety. We found that poor readers with anxiety were characterised by multiple word reading problems as well as social anxiety. The third aim of this thesis was to start to formulate a comprehensive evidence-based hypothesis about the mechanisms that may link poor reading and anxiety. In a profiling study, we investigated four potential mechanisms: poor reading self-concept, poor peer relations, poor attention, and poor behaviour. We discovered that poor reading self-concept and poor attention were particularly prevalent in poor readers with anxiety, suggesting that these variables may act as mechanisms linking poor reading and anxiety. Our fourth aim was to develop an integrated treatment for children with poor reading and anxiety. Hence, we developed "Cool Reading", which combined reading and anxiety treatment components. We carefully tailored Cool Reading to suit children with reading difficulties, and we conducted a pilot study to explore whether Cool Reading might have an effect on reading and anxiety outcomes. The results were promising, and hence the final aim of this thesis was to evaluate the suitability and efficacy of Cool Reading in a controlled interventional case series study. Overall, we found that Cool Reading significantly improved directly trained reading skills and significantly reduced anxiety. Considered together, the knowledge gained through this dissertation paves the way towards improving the lives of children with concomitant poor reading and anxiety.