Scandinavian Journal of Psychology, 2008, 49, 377384 DOI: 10.1111/j.1467-9450.2008.00661.

x
2008 The Authors. Journal compilation 2008 The Scandinavian Psychological Associations. Published by Blackwell Publishing Ltd., 9600
Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA. ISSN 0036-5564.
Blackwell Publishing Ltd
Health and Disability
Psychosocial factors and reading difculties: Students with reading
difculties drawn from a representative population sample
ANNE MARI UNDHEIM and ANNE MARI SUND
Norwegian University of Science and Technology, Norway
Undheim, A. M. & Sund, A. M. (2008). Psychosocial factors and reading difculties: Students with reading difculties drawn from a
representative population sample. Scandinavian Journal of Psychology, 49, 377384.
In a representative sample of 2,464 Norwegian adolescents, aged 1215 years, 7.8% (n = 191) reported reading difculties (RD). No gender
difference was found. Adolescents with RD were compared to classmates on psychosocial variables. In univariate analysis, RD adolescents
report higher levels of depressive symptoms, more school stress, worried more about going to school, had lower school grades and lower attach-
ment to parents than those without RD. They also scored lower on Global Self-worth and on Social Acceptance scales. Further, they reported
reduced levels of psycho-functioning during the previous year because of mental health problems, they had received more help and had used
more medication for such problems. In a multivariate logistic regression analysis, receiving help for mental health problems and reduced psycho-
functioning showed the strongest associations with student RD status. No gender interactions were found. The study demonstrated important
differences between adolescents with and without RD.
Key words: Reading difculties, school stress, school grades, attachment, self-esteem, mental health problems.
Anne Mari Undheim, Faculty of Medicine, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, N-7489
Norway. Tel: +47 73551500; fax: +47 73551539; e-mail: anne.m.undheim@ntnu.no
INTRODUCTION
Dyslexia, also known as a specic reading difculty (RD), is
the most common type among learning disabilities (LD)
which are childhood disorders affecting 45% of all school-
aged children. The proportion of children at risk for RD can
be as high as 1720% (Grigorenko, 2001) and reading dif-
culties (RD) account for approximately 8090% of all diag-
nosed LD cases (St. Sauver, Katusic, Barbaresi, Colligan &
Jacobsen, 2001). There is, however, a lack of consensus in
the eld concerning the denition of dyslexia and RD (Bishop,
2006). Developmental psychology is concerned with un-
covering the underlying basis of different disorders, and twin
studies have shown that both environmental factors and genes
are important (Bishop, 2006). The associations, however, are
very complex. In the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV; APA, 1995) and International
Classication of Diseases (ICD-10; WHO, 1994), RD is listed
among the specic developmental disorders as a common,
cognitively and behaviorally heterogeneous developmental
condition characterized primarily by severe difculty in the
mastery of reading, despite intelligence within the normal
range and adequate education. The present study uses read-
ing difculty (RD) as a common term for these problems.
There is a wide body of research documenting issues of
language development in children (Stanovich, 1999). How-
ever, few studies have focused on possible emotional problems
within this group, and few indeed using representative samples.
A few studies have shown that RD often occurs in connection
with other problems, and that it can be considered a risk
factor for social and emotional disturbances (Frisk, 1995).
Bishop and Snowling (2004) focused on the serious impact
of RD on childrens educational and psychosocial outcomes,
with school grades often being affected. Students with RD have
been shown to exhibit more frequent emotional and behav-
ioral difculties than children without these problems (Arnold,
Goldston, Walsh et al., 2005; Aviles, Anderson & Davila,
2006; Beitchman & Young, 1997; Heiervang, Stevenson, Lund
& Hugdahl, 2001; Maughan, Rowe, Loeber & Stouthamer-
Loeber, 2003). Some of the studies that investigate correlates
of depressive symptom levels have also focused specically
on reading problems. Maughan et al. (2003) reported robust
links between severe, persistent RD and increased risk of
depressed mood among boys aged 710 years in a community
sample, though not in those who had already entered their
teens. In a review of RD, Grigorenko (2001) stated that it is
crucial to highlight the relationships between various social
factors and reading problems.
Self-esteem is becoming an increasingly important concept
in the eld of child and adolescent mental health (Butler &
Gasson, 2005). An association between low self-esteem and
a raft of troubles in adolescence is suggested. In adolescence,
cognitive development enhances adolescents self-reection.
Self-criticism might lead to lower self-esteem, which in turn
has been seen to be a specic risk factor for the development
of depression (Lewinsohn, Roberts, Seeley, Rohde, Gotlib &
Hops, 1994). Adolescents with a reading problem and achieving
less than others might be especially vulnerable. Gans, Kenny
378 A. M. Undheim and A. M. Sund Scand J Psychol 49 (2008)
2008 The Authors. Journal compilation 2008 The Scandinavian Psychological Associations.
and Ghany (2003) reported that middle school students with
LD (including RD students) scored signicantly lower on
the Piers-Harries Childrens Self-concept Sub-scale of Intel-
lectual and School Status, compared with non-LD students.
Such studies tend to include small selected samples, and
larger representative samples are needed in order to be able
to generalize ndings to the adolescent population as a whole.
Adolescents with RD often experience a stressful daily life
and need much support with their schoolwork. Although
students stress levels are important to assess, they are seldom
reported in studies of RD.
Several studies have reported that the quality of adolescent
attachment to parents is associated with increased well-being,
decreased distress and emotional adjustment (Engels,
Finkenauer & Meeus, 2001; Wilkinson & Walford, 2001). Secure
attachment to parents in a previous study of the sample was
found to be a protective factor against the development of
later depressive symptoms (Sund & Wichstrm, 2002). Secure
attachment to parents might also protect against the burden
of stressors like low school grades, and give adolescents a feeling
of being good enough persons, even if school grades are dis-
appointing. Results of several studies suggest that students
with RD are vulnerable in respect of mental health problems
(Arnold et al., 2005). Help-seeking behavior is therefore
important to examine, but is seldom reported in studies.
Risk factors for mental health problems are divided into
xed (for example gender) and variable (for example stress-
related) risk factors (Kraemer, Kazdin, Offord, Kessler,
Jensen & Kupfer, 1997). RD having an organic origin might
be viewed as a xed risk factor (Bishop, 2006) for psychosocial
problems including mental health. Longitudinal studies are
necessary to assess true risk factors but also cross-sectional
studies assessing correlates might provide useful information
(Kraemer, Yesavage, Taylor & Kupfer, 2000). For prevention
in mental health, it is of particular interest to identify groups
of the population who are most at risk, and to examine how
correlates or risk factors are associated with each other. To
study correlates or possible risk factors in the population
one needs representative samples.
Aims of the study
This study assessed the prevalence of self-reported RD in a
representative school adolescent population including infor-
mation about psychosocial correlates. The strengths of these
correlates were assessed. In multivariate analysis, the relative
strengths of the associations between the correlates and RD
status were assessed. Gender differences and interactions
with gender were examined.
The hypotheses were:
Adolescents with RD report higher levels of depressive
symptoms, experience more school-stress, have lower grades
and lower self-esteem than those without RD. No hypothesis
about attachment in the RD group was proposed.
Adolescents with RD have lower psycho-functioning level,
have received more help and used more medication because
of mental health problems than non-RD adolescents.
Self-esteem moderates the relationship between school
stress and RD.
METHOD
Procedure
The present study was conducted in September 1998 as the rst wave
(T
1
) of a longitudinal study of self-reported depressive symptoms in
12- to 15-year-old students in two counties in central Norway. This
area comprises a population of 390,000 inhabitants and includes
one moderately sized city, Trondheim, with 150,000 inhabitants. A
cluster sampling technique was used and subsequently 2,464 adoles-
cents (88.3%) participated in the study. Written consent was obtained
from both the young people and their parents. The non-responders
(n = 327) at the rst data collection (T
1
) were signicantly more
often boys (X
2
(1) = 45.0, p < 0.001) and younger adolescents (X
2
(1)
= 5.47, p < 0.05). Questionnaires were completed during two con-
secutive school hours. For further details of the sampling procedure,
see Sund, Larsson and Wichstrm (2001). The present article reports
cross-sectional data from T
1
.
Participants
The sample consisted of 50.8% girls (n = 1252) and 49.2% boys (n =
1212), and the mean age was 13.7 (range: 12.515.7, SD = 0.58). The
sub-sample in the present study, students with self-reported reading
difculties, (see measures) represented 7.8 % (n = 191) of the total sample.
Demographics. Socio-economic status (SES) of the parents was
measured by the classication of the mothers and fathers occupa-
tions according to the ISCO-88 (International Labour Ofce, 1990),
see Table 1. When mothers and fathers SES differed, the fathers
SES was used, and mothers status if the adolescent lived with the
mother after a divorce or no information about father was available.
An ordinal scale ranging from 1 (highest) to 5 (lowest) was made. A
total of 93.4% had both parents born in Norway, 3.9% had one
parent born in Norway and one parent born in another country,
while 2.7% had both parents from Eastern Europe or Third-World
countries. In the analyses a dichotomized variable describing having
one or two Norwegian parents versus all other groups was used.
Four adolescents with both parents from another Western country
were not included in the analyses because the group was too small.
Of the nal sample (n = 2464), 26.9% had divorced parents.
Measures
RD (Reading difculties). In the present study, the adolescents
own information about their reading problems stems from two
questions. First, the adolescents reported whether they had dyslexia
or not; Have you had specic reading and writing problems (dys-
lexia) in the last 12 months?. We then narrowed the group by incor-
porating a second question concerning only reading difculties and
subsequently the amount of reading problems; large problems,
some problems or no problems. When students reported both
having dyslexia and at the same time large, or some, problems with
reading, they were included in the RD sample. A recent study
among British nurses (87% of the sample represented nurses in train-
ing) reports signicant correlation between dyslexia indicators, like
Scand J Psychol 49 (2008) Psychosocial factors and reading difculties 379
2008 The Authors. Journal compilation 2008 The Scandinavian Psychological Associations.
objective measures of literacy ability, and self-reported RD (Millward,
Bryan, Everatt & Collins, 2005).
There is a lack of consensus about appropriate and consistent
denition of RD in the eld (Siegel & Smythe, 2005; Stanovich,
1999), and also a wide range of language assessments are repre-
sented in various studies. For many years a discrepancy between IQ
scores and measured achievement was favored as a denition of RD
(Liederman, Kantrowitz & Flannery, 2005), because IQ scores are
thought to represent expected reading achievement (Tiu, Thompson
& Lewis, 2003). IQs role in reading still is under debate (Tiu et al.).
Cotton, Crewther and Crewther (2005) discuss measurement errors
implicated in the discrepancy model of RD and suggest this can lead
to misdiagnoses, both false positives and false negatives. Arguments
against the importance of IQ in reading are based on the perceived
strong impact of processes like decoding, listening comprehension,
and processing speed in reading comprehension (Stanovich, 1999).
Depressive symptoms. The Mood and Feelings Questionnaire (MFQ).
This is a 34-item questionnaire designed for children and adolescents
from 8 to 18 years of age, reporting depressive symptoms as speci-
ed by the DSM-IV diagnostic systems (Angold, 1989). The MFQ
covers affective, melancholic, vegetative, cognitive and suicidal
aspects of depression. The individual is asked to report on his or
her feelings during the preceding 2 weeks. Responses are made to
statements on a three-point scale (not true, sometimes true and
true). In the present sample 3-week and 3-month test-retest relia-
bilities have been reported to be r = 0.84 and r = 0.80, respectively
(Sund, Larsson & Wichstrm, 2001) while internal consistency was
alpha = 0.91 and convergent validity with the Beck Depression
Inventory (BDI) was r = 0.91 (Sund et al., 2001). MFQ is validated
in clinical samples (Daviss, Birmaher, Melhem, Axelson, Michaels
& Brent, 2006; Wood, Kroll, Moore & Harrington, 1995). High
scores represent high depressive symptom levels, range from 0
to 68.
School stress. The Early Adolescence Stress Questionnaire (EASQ).
The adolescents also lled in a questionnaire which captures stress-
ful life events, losses, and chronic stressors constructed in particular
for the present study (Sund et al., 2003). The questionnaire consists
of 33 items and comprises six subscales; school stress is one of these,
consisting of six items, like You do not get enough help with home-
work. The adolescents reported whether a certain event or stressor
had occurred during the last 12 months, and a sum score was calculated.
High scores represent high stress level, range from 0 to 6.
Grades. The Norwegian elementary school does not grade the
students results formally until the eighth grade. Before that age,
students reported their school results on a four-point scale from
failure or far below mean to above mean for six different school
subjects (Norwegian, English, math, science, gymnastics, art). Total
scale scores range from 1 to 24. A mean grade score on the six subjects
was then computed. High scores represent high grades, range 1 to 4.
Self-esteem. Self-esteem was measured by a revised version of the
Self-Perception Prole for Adolescents (SPPA) (Harter, 1988; Wich-
strm, 1995). The SPPA consists of several subscales, each domain
measured by ve items. Each domain is scored on a four-point scale
from applies very well to applies very badly. This study adminis-
tered the three following subscales; Global Self-worth, Social Acceptance,
and Physical Appearance. Internal consistency, as assessed by
Cronbach alpha, for the sub-scales Global Self-worth and Social
Acceptance, was 0.80, and 0.89 for the sub-scale Physical Appearance.
A mean item score was computed for each of the scales. High scores
represent high self-esteem, range 1 to 4.
Attachment to parents and peers. The Inventory of Parent and Peer
Attachment (IPPA) (Armsden & Greenberg, 1987) is an attempt to
measure affectively toned expectancies to parents and friends asso-
ciated with internalized representations of each attachment. In the
present study, we used the revised version (25 items) that rates the
parents individually (Armsden & Greenberg, 1989). The IPPA uses
a ve-point scale format (1 = almost never true, 5 = almost
always true). High scores reect greater perceived attachment than
do low scores and reects more secure attachment. Armsden and
Greenberg (1987) have reported high validity and high test-retest
reliability for the questionnaire. Sum scores were calculated sepa-
rately for the mother and father IPPA scale, parents scales ranging
from 1 to 125 and friends scale ranging from 1 to 30.
Functioning level. They were asked a range of questions (Yes/No)
about their functioning last year; A general question about functioning
level was asked (Y/N): When you are worried or sad (having emotional
or psychiatric problems) does it happen that you do not function as well
as usually? They were also asked about reduction of leisure activities
and absence from school because of such problems (Y/N). The adole-
scents were also asked if they worried about going to school, graded on
a four-point scale from agree very much to agree not at all. In addi-
tion, help-seeking behavior was assessed (Y/N), if they had received
help because of mental health problems (from teachers/counselors,
Table 1. Demographic characteristics of a representative sample of young Norwegian RD (n = 191) and non-RD adolescents (n = 2273)
RD n = 191 Non-RD n = 2273 Group difference
Gender
Girls n = 1252 88 (7.0%) 1164 (93%) Ns
Boys n = 1212 103 (8.5%) 1109 (91.5%)
SES
a

2
= 23,24***
Professional leader
b
n = 241 13 (6.8%) 228 (10.0%) ns
Upper middle class
b
n = 704 29 (15.2%) 675 (29.7%) p < 0.05
Lower middle class
b
n = 326 26 (13.6%) 300 (13.2%) Ns
Primary industry
b
n = 204 15 (7.9%) 189 (8.3%) Ns
Manual worker
b
n = 899 92 (48.2%) 807 (35.5%) p < 0.05
SES missing
b
n = 90 16 (8.4%) 74 (3.3%) p < 0.05
Ethnicity (one or both Norwegian parents vs. all others)
a
9 (4.7%) 65 (2.5%) ns
Parents divorced
a
n = 663 68 (37%) 595 (27.1%)
2
= 8.24**
a
Pearson
2
test.
b
Condence interval around the differences.
** p < 0.01; *** p < 0.001; ns = non-signicant.
380 A. M. Undheim and A. M. Sund Scand J Psychol 49 (2008)
2008 The Authors. Journal compilation 2008 The Scandinavian Psychological Associations.
school nurses, medical practitioners, psychologists, psychiatrists) or
used any medication for mental health problems during the last year.
Analysis
On the RD variable, 2% of the adolescents had missing data. On the
various scales in the study, the percentage of missing data varied
between 0.8% and 13%, except on the IPPA father variable, where
18% of the data were missing. If more than 10% of the items were
missing on the various scales, the subject was not included in the
analyses. Otherwise, the missing values were replaced with mean
value for that person on the other items on the scale. Combining
variables in the nal multivariate analysis somewhat increased the
number of missing cases.
Associations between categorical variables were analyzed by Pearson

2
tests. Differences between group means were analyzed by Students
t-test for continuous scale scores and with Mann-Whitneys test for
ordinal scale scores. To adjust for multiple testing, the alpha level
(p = 0.05) was divided with all variables in the study, and a level of
p = 0.003 was chosen on the univariate level. The condence intervals
around the differences between proportions (Bjrndal & Hofoss,
2004) were used when assessing the relationships between the RD/
non-RD groups and the SES groups. Multivariate logistic regression
analyses were performed to examine differences among adolescents
with and without RD on those variables that signicantly distinguished
between the two groups in the bivariate analyses. The results of
multicollinearity checks showed that the square root of the Variance
Ination Factor was well below the conventional limit of 2.0 for all
variables, and the tolerance was between 0.495 and 0.949.
RESULTS
The RD prevalence rate was 7.8% with no signicant differ-
ence between the genders (7.0% girls and 8.5% boys). No
signicant age difference was seen.
Univariate analyses
The RD and non-RD groups were compared on socio-
demographic variables. More RD than non-RD adolescents
reported having divorced parents. The analysis of the SES
groups showed signicant differences between the RD and
the non-RD group. RD occurred signicantly more frequently
in the manual workers group, and less so in the upper middle
class group, see Table 1. The analyses of functioning level and
help seeking behavior showed signicant differences between
the RD and non-RD adolescents, see Table 2.
The results further showed that RD adolescents differed
from non-RD adolescents on the following psychosocial vari-
ables: they had higher depressive symptom level scores, experi-
enced more school stress, worried more about going to school,
had lower grades, lower self-esteem on two of the three
subscales, and lower attachment scores to parents, but not
to friends, see Table 3. A signicantly (p < 0.001) higher
proportion of RD adolescents was also found among the
Table 2. Differences in regard to psycho- functioning level and help seeking behaviour (yes/no), between young Norwegian RD (n = 191)
and non-RD adolescents (n = 2273)
Table 3. Differences between RD (n = 191) and non-RD adolescents (n = 2273) in mean scores (SD and df within parentheses) on various
psychosocial variables
Variables RD n = 191 (8%) Non-RD n = 2273 (92%) Group differences
Reduced functioning n = 465 76 (44.2%) 389 (17.7 %)
2
= 70.70***
Reduced leisure activities n = 69 11 (6.5%) 58 (2.6%)
2
= 8.14*
Absence from school n = 78 10 (6.8%) 68 (3.7%) ns
Psychotropic medication n = 36 15 (10.1%) 21 (1.1%)
2
= 62.0***
Help for mental health problems n = 121 28 (16.7%) 93 (4.4%)
2
= 46.39***
* p < 0.05; ** p < 0.01; *** p < 0.001; ns = non-signicant.
RD Non-RD Group difference
MFQ (068)
a
16.09 (11.46) 10.19 (9.21) t = (2441) 6.89***
IPPA mother (1125)
a
95.98 (18.23) 101.69 (14.94) t = (2326) 3.96***
IPPA father (1125)
a
94.25 (18.04) 97.51 (16.33) t = (2242) 2.19*
IPPA friends (1 30)
a
21.73 (5.12) 22.24 (4.77) ns
Worrying going to school (14)
b
3.55 (0.78) 3.20 (1.04) z = (2428) 4.68
School stress (06)
b
2.23 (1.44) 1.20 (1.28) z = (2427) 9.55***
Grades (1 4)
2
2.54 (0.58) 3.05 (0.50) z = (2288) 10.76***
Global self-worth (14)
b
2.88 (0.71) 3.04 (0.62) z = (2372) 2.84**
Social acceptance (14)
b
2.98 (0.57) 3.18 (0.51) z = (2370) 4.59***
Physical appearance (14) 2.68 (0.79) 2.72 (0.75) ns
a
Student t-test.
b
Mann-Whitney U-test.
* p < 0.05; ** p < 0.01; *** p < 0.001; ns = non-signicant.
Scand J Psychol 49 (2008) Psychosocial factors and reading difculties 381
2008 The Authors. Journal compilation 2008 The Scandinavian Psychological Associations.
10% highest scorers on the MFQ, 23% vs. 9% as compared
to non-RD adolescents.
Multivariate logistic regression analyses
The signicant variables in the bivariate analyses (Tables 2
and 3) were included in a logistic regression analysis predict-
ing group membership, i.e. having RD, when the effect of
gender was controlled. The results showed that a model
including receiving help for mental health problems, general
functioning level, school stress, school grades, social accept-
ance, and SES groups, signicantly predicted group member-
ship, see Table 4. Nagelkerkes R square was 20.2%, and
the HosmerLemeshow test was non-signicant indicating
that the t of the model was good (p = 0.87). Separate logistic
regression analyses performed to assess possible interactions
on the RD status, including the interaction between school
stress and the self-esteem variables: Global Self-worth and
Social Acceptance scales showed no interactional effects,
neither were interactions with gender found.
DISCUSSION
The estimated RD prevalence rate (7.8%) in our study of
1314-year-old school adolescents was within in the range
of 310% suggested by others (Heiervang et al., 2001; St.
Sauver et al., 2001; Willcutt & Pennington, 2000). It is
possible that some students with general learning difculties
reported that they had RD, thereby giving an increased
prevalence estimate due to false positives.
The present sample of students with self-reported RD was
drawn from a representative school population. Our study
demonstrated no prevalence difference between the genders.
Selected samples tend to include more boys. These ndings
are also in line with the ndings of Hawke, Wadsworth and
DeFries (2006) who reported no or little evidence for a
different genetic etiology of reading difculties in males
and females. No interaction between gender and the psycho-
social variables on the RD status was found.
The rst hypothesis of this study was conrmed, i.e.
adolescents with RD reported more problems in most of the
psychosocial areas measured, i.e. more depressive symptoms,
more school stress, more worrying about going to school,
lower grades, lower global self-worth as well as feeling less
accepted among peers. They also showed lower attachment
levels toward both of the parents. Overall, adolescents with
RD denitely stood out as a group struggling more than
others.
The higher depressive symptom level measured by the MFQ
cross-sectionally was consistent with earlier ndings among
young RD boys (Maughan et al., 2003), and high rates of
internalizing problems, including depression and somatic
complaints in other studies (Arnold et al., 2005; Willcutt &
Pennington, 2000). The present study also disclosed a signi-
cantly higher number of RD adolescents among the 10%
high scorers on the MFQ compared with the low/medium
scorers, indicating a severe problem level in this group. The
depressive symptom levels, however, did not predict RD in
multivariate analyses, a surprising nding, that might mirror
the somewhat narrow scope of the present study. The effect
of depressive symptoms might be mediated through the
variables such as school stress, help for mental health
problems or reduced functioning.
The RD students need to work harder than non-RD
students for their grades, and the results seldom reect their
input of work (Bishop & Snowling, 2004). School stress is
an easy understandable consequence, clearly shown in the
present study. However, even if adolescents with RD worried
signicantly more about going to school, they reported no
more absence from school than non-RD students. This nd-
ing is consistent with interview information from young
adults 23 years of age (Undheim, 2003) suggesting that being
at school, listening to teachers instructions, and discussion
in the classroom was an important strategy to compensate
for their RD. In the multivariate analyses both low grades
and high school stress independently predicted membership
in the RD group.
Even if adolescents with RD showed lower global self-worth
in bivariate analysis, global self-worth did not predict RD in
multivariate analysis. The lower scores found bivariately
might be mediated through the strong effect of lower grades
or belonging to lower SES in the RD group. More than others,
the RD students could need support from friends. Feeling
less socially accepted, however, might discourage them from
seeking such support. In the multivariate analyses, the
negative association between feeling socially accepted and
Table 4. The result of logistic regression analyses in prediction of Reading Difculties (RD) (n = 191) in a population sample of young
Norwegian adolescents (n = 2464)
Predictor B (SE) OR, 95% CI
School stress (06) 0.33*** (0.08) 1.39 (1.191.62)
School grades (14) 1.04*** (0.20) 0.36 (0.240.53)
Social acceptance (14) 0.53* (0.24) 0.59 (0.370.93)
Reduced functioning (Y/N) 0.56* (0.26) 1.75 (1.062.89)
Help for mental health problems (Y/N) 0.84* (0.36) 2.32 (1.154.71)
SES (15) 0.29*** (0.08) 1.34 (1.141.56)
* p < 0.05; ** p < 0.01; *** p < 0.001.
382 A. M. Undheim and A. M. Sund Scand J Psychol 49 (2008)
2008 The Authors. Journal compilation 2008 The Scandinavian Psychological Associations.
having RD was maintained, and this result points to a pos-
sible intervention area; i.e. improving social relationships
with peers that seem to be a problem for adolescents with
RD. However, the RD adolescents were not more dissatis-
ed with their physical appearance than others. Their self-
esteem seemed to be more inuenced by intrinsic, social and
achievement factors.
The lower attachment scores to the parents found in the
RD group might depend on a higher load of schoolwork
straining the relationships in the families. Attachment to
parents, however, did not predict RD multivariately. This is
a positive nding: Even if students with RD have low grades,
and experience much school stress and feel less accepted by
peers, they do not have less secure attachment to their parents.
The role of socioeconomic status in connection with RD
problems is also consistent with earlier ndings (Grigorenko,
2001), but is seldom reported in Norwegian studies. The
results showing that the parents of RD adolescents more
often tended to be manual workers and less often were from
the upper middle class group than parents in the non-RD
group, are consistent with the ndings of Heiervang et al.
(2001). Manual workers schooling is probably less theoretical,
rendering the parents less able to help their adolescents with
homework. These families, more than others, need support
with school work.
Supporting the second hypothesis, adolescents with RD
reported lower psycho-functioning level, more often the use of
psychotropic medication, and had received more help for mental
health problems during the last year than non-RD adolescents,
indicating a stressful life situation. It is thought-provoking
that already at the age of 14, both the amount of school stress
and utilization of help for mental health problems indicated
membership in the RD group of adolescents. This nding
demonstrates the extensive need for support in this group,
and is in accordance with ndings of higher levels of psychi-
atric disorders among poor than among typical readers in
studies by Arnold et al. (2005) and Beitchman et al. (2001).
The third hypothesis was not conrmed in that no support
was found for self-esteem moderating the relationship between
school stress and having RD. The level of stress did not vary
with level of self-esteem and these entities should be there-
fore viewed as separate areas of intervention.
However, the cross-sectional design used in the present
study cannot support inference about causal factors.
A limitation of the present study was the covering of one
geographical region in Norway, including only one moder-
ately sized city which might under-represent urban areas.
All information was self-reported; i.e. adolescents might have
misunderstood questions because of RD problems, non-
Norwegian ethnical background or low cognitive functioning
level. All information relied on the adolescents own self-
report. Complementary sources of information from teachers
or parents might have added useful information. However,
psychosocial factors like depression and self-esteem might
be difcult to recognize for others and one must rely on
adolescents own statements. Since only depressive symptoms
were assessed in this study, and no diagnosis, the clinical
signicance of the nding is limited. The tendency among
the RD students to have more missing data might lead to an
underestimation of the ndings rather than the opposite.
Although this study also lacked individual testing of RD
problems, the epidemiological design of this study prevented
that. This study invites the adolescents to evaluate their own
reading skills. As junior high school students, they should
be mature enough for such judgement, and possible early
developmental lag should be mastered. As the present study
did not use cognitive measures, the RD group might also
include people with low cognitive functions. Stanovich (1988,
1999), however, discussed the role of cognitive measures in
RD diagnosis.
The strengths of this study were a large representative sample,
a high response rate and the use of a standardized self-report
measure of depressive symptoms based on DSM-IV symptom
criteria, as well as well-known measures on self-esteem and
attachment. Large samples are needed in this area, and out-
comes of the present study contribute to the eld with a large
representative sample. Thoroughly tested samples tend to be
much smaller. Generally few missing data were found. The
study also assessed functioning level from different perspec-
tives, which few other studies to date have done. The study
included adolescents before the age when school dropout is
considered a serious problem, and consequently represents a
representative student population.
This study showed important differences between adoles-
cents with and without RD relating to psychosocial variables.
When the ndings were considered all together, factors asso-
ciated with school were strongly associated with RD status,
i.e. school stress, low grades and feeling less socially accepted
by peers. School settings might be a good place for preven-
tion of mental health stressors, both for universal programs
addressing the whole school population, as well as for targeted
programs for groups at increased risk for psychopathology
(Gillham & Reivich, 1999; Paternite, 2005). Teachers are in
a position to offer both educational and emotional support
to the individual, and to participate in improvement of the
school environment to create more stimulating educational
possibilities for vulnerable groups like the RD group. Pre-
ventive work in school might inuence the general health of
this group. Also, health services should be aware of young
people seeking help who might have educational needs and
need help to relieve psychosocial problems and manage stress
and social challenges.
This study was supported by grants from the Research Council of
Norway and from the National Council for Mental Health Norway.
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Received 15 August 2006, accepted 17 January 2008