Evaluation of the Bangor Dyslexia Test (BDT) for use with Adults

Andrea Elaine Reynolds and Markéta Caravolas

School of Psychology, Bangor University, Bangor UK

Abstract

The Bangor Dyslexia Test (BDT) is a short, easy-to-administer screener for use with a

broad age range, which has been in use in the United Kingdom for over three decades. A

distinctive feature of the battery is its focus on skills requiring aspects of verbal and

phonological processing without, however, measuring literacy skills per se. Despite its

longstanding existence and usage, there has been no evaluation of the psychometric

properties of the battery as an adult dyslexia screener. We examined the psychometric

properties of the BDT and evaluated its capacity to discriminate between adults with and

without dyslexia. A large archival sample of university students with dyslexia (n = 193) and

students with no reported literacy difficulties (n = 40) were compared on the BDT as well as

on literacy and cognitive measures. Statistical analyses revealed the BDT to be a reliable (α =

.72) and valid dyslexia screening tool with the capacity to effectively identify adults at risk of

the disorder with an overall classification rate of 94% (sensitivity 96.4% and specificity

82.5%). In addition, higher indices of dyslexia risk on the BDT were associated with lower

scores on standardized measures of literacy.

Keywords: dyslexia; adults; screening test; higher education; Bangor Dyslexia Test;

evaluation

Practitioner Points:

 The BDT can be used by practitioners to effectively screen for dyslexia in adults
 Knowledge of the psychometric properties of screening tests is useful for the selection

of the most appropriate tools

 Independent research is one method of confirming/validating the effectiveness of

screening tests

 Continuing independent research ensures that screening tests remain appropriate in

light of our increased knowledge and understanding of dyslexia

Introduction

The ability to detect dyslexia in adults presents a challenge to many employers and

educational institutions. While the mechanisms and tools for the diagnosis of dyslexia, and

support for those affected are quite well established for school children in many countries

(e.g., Rose Review, 2009; Caravolas, Kirby, Fawcett, & Glendenning, 2012), they are less

advanced for adults in the higher /further education sector and in the workplace. The need for

reliable and valid diagnostic tools is pressing, because several acts of legislation in the United

Kingdom, such as the Disability Discrimination Act of 2005, Special Education Needs and

Disability Act (SENDA), 2001, and the Equality Act 2010 (also similar legislation and

initiatives worldwide e.g., United States Department of Education Individuals with

Disabilities Education Act, 2004; United Nations Educational Scientific and Cultural

Organization Salamanca Statement on Special Needs Education, 1994), now exist to prevent

discrimination against people with disability (including dyslexia) in access to services,

education, and employment. Moreover, these laws call for education providers and employers

to identify and support students and employees with dyslexia. The SENDA (2001)

specifically requires that disabled students and employees are treated fairly, and that
reasonable adjustments are made to alleviate obstacles to their learning and/or job

performance.

Not coincidentally, the number of students with disabilities entering higher education

in the United Kingdom, including a large proportion with dyslexia, is rapidly increasing

(Higher Education Statistics Agency, 2008). This is true not only for the United Kingdom,

but also in other countries such as France, Germany, Canada (Organization for Economic Co-

operation and Development, 2003), and the United States of America (Raue & Lewis, 2011).

In the United Kingdom, a significant percentage (approximately 43%) of students with

dyslexia is only identified after admission to post secondary institutions (National Working

Party on Dyslexia in Higher Education, 1999; Singleton, 2004). Nicolson, Fawcett, & Miles

(1993) have furthermore suggested that in the wider work community, the number of adults

with undiagnosed dyslexia may be high. Thus, both higher education institutions (HEIs) and

employers require knowledge of and access to effective dyslexia screening and/or assessment

tools in order to fulfill their legal and professional obligations. Screening tests (screeners) are

broadly designed to be quick, cost effective, and easy-to-administer tools for identifying

individuals most at-risk of a disease or disorder. While administrators should be trained to

administer specific screeners in accordance with their published instructions, they do not

require specific professional qualifications, as in Educational Psychology, Speech and

Language Therapy, or Specialist Dyslexia Teaching (e.g., Singleton, Horne, & Simmons,

2009). Screeners may thus be useful for HEIs and employers, who lack the means and/or the

access to full diagnostic assessment services, in the identification of individuals who may be

at-risk of dyslexia.

Very few dyslexia screeners are available for adults, and, of these, there is no

generally accepted or “gold standard” battery. In the UK, two frequently used paper based
tests are the BDT (Miles, 1997) and the Dyslexia Adult Screening Test (DAST) (Fawcett &

Nicolson, 1998). The main computerized screening tests include: Lucid Adult Dyslexia

Screening Plus (LADS Plus) (Lucid Research Limited, 2010), QuickScan (Zdzienski, 1998),

and Instines (Dyslexia Foundation http://www.dyslexia-check.com/instines01.htm). Although

these tools have been in use for several years (the BDT for almost three decades), there is a

still a paucity of published research evaluating them. HEIs and employers may therefore find

it difficult to select the most appropriate batteries for their contexts. This paper presents an

empirical evaluation of the psychometric properties of the BDT as a screener of dyslexia in a

population of university students. We investigated the BDT because it is in use in the UK

(not least Bangor University) and several other countries, having been widely translated and

being easy to administer (Miles, 2006).

Manifestations of Dyslexia in Adulthood

To accurately identify adults at-risk of dyslexia, an understanding of how the disorder

manifests in affected adults is important. Similar to children, adults with dyslexia exhibit

specific deficits at the behavioural level, as well as differences at the brain and genetic levels

(see Sun, Lee, & Kirby, 2010; Swanson & Hsieh, 2009; Wagner, 2005 for reviews). Over and

above weaknesses in reading efficiency (accuracy and speed) and spelling, behavioural

markers most typically include difficulties in the accuracy and/or speed of processing

phonological (speech sound) information, and verbal memory (Nergard-Nilssen & Hulme,

2014; Vellutino, Fletcher, Snowling, & Scanlon, 2004). In addition, single or multiple

deficits have sometimes been reported in the domains of language use and comprehension,

auditory and speech perception, visual attention, motor coordination, and associative learning

(Vellutino et al., 2004). The prevalence of each type of difficulty and their rates of co-

occurrence have not yet been clearly established in the adult dyslexic population, however,
deficits in phonological processing and verbal short term memory tend to predominate both

in terms of severity and frequency (Bruck, 1992; Gathercole, Alloway, Willis, & Adams,

2006; Nergard-Nilssen & Hulme, 2014; Snowling, et al., 1997).

To date, few longitudinal studies have tracked dyslexic individuals from childhood

into adulthood (e.g., Undheim, 2009; Snowling, Muter, & Carroll, 2007; Svensson, &

Jacobson, 2006), however, it is clear that despite the persistence of underlying deficits in

dyslexia, some changes in the behavioural manifestations of difficulties do occur. For

example, by adulthood many English-speakers with dyslexia are able to close the gap in

reading accuracy (though rarely also in fluency) relative to typical readers (Kemp, Parrila, &

Kirby 2009). However, spelling accuracy as well as phonological processing speed tend to

remain impaired into adulthood, and this across languages (Callens, Tops, & Brysbaert, 2012;

Judge, Caravolas, & Knox, 2006). The mounting evidence of heterogeneity in the cognitive

profiles of dyslexic individuals has led to recent (re)conceptualizing of dyslexia as a

multidimensional disorder, which stems from the interaction of possibly multiple deficits,

varying in severity (Pennington, 2006; Rose Review, 2009). In line with these current trends,

Miles (1993) conceived of dyslexia very much as a complex of cognitive strengths and

weaknesses, despite the disorder having its primary basis in the domain of language

processing (Miles, 1961). The BDT was thus constructed to reflect this view.

The BDT: A Screener of Dyslexic Traits.

The BDT was one of the first dyslexia screening tests to be developed in the United

Kingdom, designed by the late Tim R. Miles in 1983 as a battery of ten subtests for use

across a wide age range, from 7 years to adulthood (Miles, 1993). Miles believed dyslexia to

be a syndrome with a distinctive pattern of symptoms/difficulties resulting primarily from a

lexical or verbal labelling deficit, which he considered to reflect an underlying phonological

processing deficit (e.g., Miles, 2006; Miles, 1993; Payne, Miles, & Wheeler, 2007). The

selection of subtests was mainly informed by observational evidence gathered during Miles’

clinical work with dyslexic individuals, which he believed could identify their pattern of

difficulties. The test is a non-threatening set of simple tasks, in which the test taker can

engage confidently without time pressure (although the whole battery should take no longer

than 30 minutes to complete).

A unique feature of the BDT, setting it apart from other dyslexia screening tools, is its

emphasis on quick and easy-to-administer tests that do not directly assess reading and

spelling skills. Thus, the BDT subtests were conceived as more distal markers of the array of

difficulties in the oral language domain that may underlie dyslexics’ literacy difficulties. This

conceptualization has not gone without some criticism, with concerns being raised regarding

both the objectivity of the scoring system and the specificity of the battery given its exclusion

of literacy measures (Sutherland & Smith, 1991). Norms and validation for some subtests of

the BDT were established from a large, nationally representative cohort of children aged 10-

11 years, participating in the Child Health and Education Study (see Miles (1993), and Miles,

Haslum, & Wheeler (1998) for details), but wider norms including adult populations have not

been published. The validation study (Miles, 1993) focusing on three subtests Left-Right,

Months Forwards, and Months Reversed, revealed that children with positive scores tended to

be more educationally disadvantaged than those with negative or zero scores.

As is true of other screening tests, independent research on the BDT is very limited

and there are no studies evaluating its psychometric properties. Cognizant of this lack, in the

present study, we assessed whether the BDT possesses psychometric properties that are

adequate for use with an adult student population. We made use of the archival database of

screening and full assessment outcomes of students at Bangor University, where the BDT has
long been in use by the Student Dyslexia Service. Specifically, we investigated its reliability

and its construct and predictive validity. If the BDT is an adequate screening tool for adults,

we expected the students’ data on each subtest and on the battery as a whole to yield robust

estimates of internal consistency. Additionally, we expected that if the (non-literacy) subtests

of the BDT are valid indicators of literacy difficulties, then adults with dyslexia should obtain

higher scores than those without the disorder. Moreover, we expected that: (1) BDT scores

would correlate more strongly with standardized measures of literacy than with nonverbal

cognitive measures, and (2) dyslexia-risk status as determined by the BDT would predict

fully diagnosed (by EP) dyslexia status, and dyslexic versus non-dyslexic group membership

in logistic regression.

Method

Participants

Two groups participated in the study: a dyslexic group selected from the Miles

Dyslexia Centre’s archived data, and a control group that was recruited from among Bangor

University students who had no history of learning difficulties.

Dyslexic sample. Data were obtained from the archived records of 373 students who

were screened and assessed at the Miles Dyslexia Centre of Bangor University between

September 2004 and October 2008. Students self-referred to the Centre on a voluntary basis

and data were collected and stored electronically for those who had given written consent for

their data to be used for research purposes. The participants in question were studying in a

wide range of disciplines including Psychology, Nursing, Sports Science, Zoology, Marine

Biology and Social Work. The majority were undergraduates 337 (90%) and 38 (10%) were

postgraduates; 325 (87%) were first language English speakers.

Of the original sample (N = 373), 348 students were referred for a full assessment

because their screening outcomes (see Procedure) indicated risk of dyslexia or of other

learning disorders. Of this referred group, 230 undertook the full assessment; the screening

and assessment outcomes of these students are detailed in Table 1. The majority, n = 193,

were diagnosed with dyslexia and comprised the dyslexic group in the ensuing analyses.

Characteristics of the group are detailed in Table 2.

Table 1

Screening and Diagnostic Outcomes of Participants Undertaking Full Assessment (n = 230)

with Totals for Each Category

Screening Full Diagnostic Assessment Outcomes

Indications of Dyslexia Dyspraxia Other Working/Short Others No Disability
Risk of Specific Learning Memory Specified
Difficulties (n) Disorders Disorders
Dyslexia (183) 156 8 10 1 4a 4
Dyspraxia (10) 4 2 2 1 1b -
Attention Deficit 1 - - - - -
Hyperactive
Disorder (1)
Other Learning 3 - 1 - - -
Disorders (4)
Disorder not 29 1 - 1 1d -
Specified (32)c
Total 193 11 13 3 6 4
Notes. For Other Learning Disorders the extra nature of these were not specific by the
assessors.
a
Disorders diagnosed were as follows: Attention and Concentration Difficulties – 1, Myalgic
Encephalomyelitis – 1, General Learning Difficulties – 1, and Information Processing
Weakness – 1.
b
Disorder diagnosed Writing Speed Difficulty
c
Assessor did not specify, however, primary risk of dyslexia is assumed.
d
Disorder diagnosed Learning Weaknesses
Control sample. Control participants were 40 psychology undergraduates recruited

through a student participation panel. All had English as their first language and reported no

history of learning difficulties; they were compensated with course and printer credits.

Characteristics of the group are detailed in Table 2. The groups differed statistically in age,

t(230.99) -7.22, p < .001.

Table 2

Characteristics of Participants for Dyslexic Sample and Sub-samples (participating in

Different Statistical Analyses) and Control Sample

Characteristics Dyslexic Control

Reliability and MANOVA
Logistic Regression
N 193 97 40
Age
M 24.5 24.93 19.50
SD 8.76 9.36 1.81
Gender
Male 61 28 10
Female 132 69 30
First Languagea
English 164 79 40
Welsh 19 15 -
Other 2 1 -
Note. The difference between the numbers for the language groups and the total sample is due
to missing data on language background for 8 participants.

Bangor Dyslexia Test

The BDT comprises ten subtests: eight skill-based tasks, and two anecdotal queries

about persisting confusion of the letters b and d, and report of other family members with

similar difficulties. Descriptions of these subtests are provided in Table 3. In the present
paper, we do not take a position on the causal mechanisms that may (or may not) be

measured by the subtests of the BDT, but rather our aim is to assess the battery’s ability to

discriminate between adult students with and without dyslexia. For example, reports of

persistent confusions between similar-looking letters (e.g., b and d) may be more prevalent

among individuals with dyslexia because they reflect one aspect of the well documented

delays in letter learning and spelling skills in this population (e.g., Treiman et al., 2014),

rather than a specific neurological impairment in discriminating letter-shape orientation, as

has sometimes been proposed (e.g., Orton, 1937). Similarly, adults with dyslexia may

experience greater difficulties responding to instructions in the Left-Right test due to verbal

short term memory difficulties and not a core difficulty in telling left from right. Thus, it is

conceivable that the test comprises a sensitive battery of behavioural markers of literacy

difficulties, even though current thinking might provide somewhat different explanations for

their sensitivity than were originally posited.

The scoring system as detailed in the manual (Miles, 1997) is deliberately simple

allowing only three possible scores for each subtest: + (plus) a dyslexia positive response, -

(minus) a dyslexia negative response, and 0 (zero) an ambiguous response, not clearly

dyslexia-positive or negative. In addition to response accuracy for 8 of the subtests

(excluding B-D Confusion and Familial Incidence), scoring is also based on the assessor’s

clinical judgement, taking into account any manifest difficulty experienced or explicit

strategies used by the assessee to achieve the response. Indications of difficulties experienced

by the test taker include hesitations, requests for repetitions of the question, repeating the

question before answering, and other manifest difficulties. Therefore, a + score would be

given not only for incorrect responses, but also for correct responses meeting the criteria of

response difficulty. A score of – is awarded for correct responses with no indication of

difficulties or strategies, and a score of 0 is awarded for correct responses in which the
behavioural evidence of difficulty is ambiguous. These subtest scores are then assigned

numerical values such that + = 1, 0 = .5, and - = 0, which are summed for a minimum of 0

and a maximum of 10 points. The BDT prescribes no unique cut off score for indicating risk

of dyslexia. According to Miles (1997), the assessor should determine each individual’s’ at-

risk score based on their performance on the BDT and other information (such as personal or

educational history). For research purposes, however, he suggested that five or more pluses in

children and four or more pluses in adults indicate the presence of dyslexia, and a score of

three or less indicates its absence.

Procedure

Screening procedure for the dyslexic sample. All students were screened

individually at the Miles Dyslexia Centre by trained professionals with qualifications in

assessing and teaching individuals with Specific Learning Difficulty (SpLD). The screening

procedure included: (1) the Bangor Dyslexia Test, administered and scored in accordance

with published instructions (Miles, 1997); (2) a semi-structured interview probing

information about prior and current academic difficulties, general background, medical

history, and any post-secondary experience including educational or work activities; (3) a

timed (3-minute) free writing test to assess writing speed; and (4) four subtests of the

Dyslexia Adult Screening Test (DAST) (Fawcett & Nicolson, 1998), as follows: Nonsense

Passage Reading, Two Minute Spelling, Phonemic Segmentation, and Verbal and Semantic

Fluency.
Table 3

Description of the Subtests of the Bangor Dyslexia Test

Subtests Descriptions Skills Assessed

Left – Right Tests the awareness of left and right using Verbal working memory,
body parts. e.g. “Point to my right ear with spatial awareness, and mental
your left hand”. Eight items. rotation.

Polysyllabic Tests the ability to repeat polysyllabic Verbal/phonological short

Words words such as ‘preliminary’ and term memory and articulatory
‘philosophical’. Five items. accuracy.

Subtraction Tests the ability to complete verbally Verbal working memory and
presented subtraction problems. e.g. “52 arithmetic skills.
take away 9”. Six items

Tables Tests the ability to recite 6, 7 & 8 times Rote and verbal working
tables. Three items. memory, arithmetic skill, and
executive functions for
sequencing.

Months Tests the ability to recite the months of year Rote recall and executive
Forwards in the correct order. One item (trial). function for sequencing.

Months Tests the ability to recite the months of the Verbal working memory and
Reversed year in reverse order. One item (trial). executive function for
sequencing.

Digits Tests the ability to repeat digits in the order Verbal short-term memory.
Forwards in which they were presented. Consists of
two blocks of six items. Twelve items.

Digits Tests the ability to repeat digits in the Verbal working memory.
Reversed reverse order of presentation. Consists of
two blocks of three items. Six items.

B–D Question: “Is there any evidence that the Not applicable
Confusion subject confuses ‘b’ and d’ or did so beyond
the age of 8?”

Familial Question: “Is there evidence of anyone else Not applicable

Incidence in the family having similar difficulties?”

The Nonsense Passage Reading subtest consists of a short passage of real and nonsense

words to be read aloud for a maximum of three minutes (reported test-retest reliability r =
.92). The Two Minute Spelling subtest consists of up to 32 words graded in difficulty, and

spelled to dictation for 2 minutes (reported test-retest reliability r = .93). The Phonemic

Segmentation subtest includes 12 syllable/phoneme deletion items and 3 spoonerism items

(reported test-retest reliability is r = .90). The Verbal and Semantic Fluency subtest requires

the rapid generation of words on the basis of either alliteration or meaning for a duration of

one minute (reported test-retest reliability is r = .81 for Verbal Fluency and r = .76 for

Semantic Fluency). The DAST subtests were administered and scored according to published

guidelines and followed the semi-structured interview and the administration of the BDT.

Note that the present study aims to evaluate only the psychometric properties of the BDT, and

not the validity of the full screening process.

Full assessment procedure for the dyslexic sample. Students whose screening

outcomes, including their BDT performance, indicated that they were at risk of dyslexia or

other learning disabilities were referred for full assessment. For the period under study

(September 2004 to October 2008), all but two assessments (completed by Specialist

Teachers) were carried out by Educational Psychologists (EPs). Students were assessed on a

battery that included subtests of the Wechsler Adult Intelligence Scale III (WAIS III)

(Wechsler, 1997), usually administered were Vocabulary, Block Design, Verbal

Comprehension, Perceptual Organization, Working Memory and Processing speed. Literacy

attainment (reading, spelling and reading comprehension) was assessed using the Wechsler

Individual Achievement Test II (WIAT II) (Wechsler, 2005), Wide Range Achievement Test

III (WRAT III) (Wilkinson & Robertson, 2004), and/or the Wechsler Objective Reading

Dimensions (WORD) (Wechsler, 1993). The general practice among the EPs at that time for

diagnosing dyslexia was based on a discrepancy between IQ and literacy attainments.

Testing procedure for control participants. All students were tested individually in

a quiet room in a session lasting approximately 60 minutes. Students were assessed on the

BDT as well as on measures of literacy attainment using the Word Reading, Spelling, and

Sentence Completion subtests of the WRAT IV (Wilkinson & Robertson, 2004) and, verbal

and non-verbal ability using the Vocabulary and Matrices subtests of the Wide Range

Intelligence Test (WRIT) (Glutting, Adams, & Shelow, 2000). Ethical approval for the study

was granted by the School of Psychology, Bangor University.

Results

Comparisons of Performance of Dyslexic and Control Groups on Background Measures

Prior to the main analyses of the BDT, we compared the two participant groups on

cognitive ability and literacy measures. Although the dyslexic and control groups were

assessed on different background measures, all are well established, standardised, and widely

used for research and assessment purposes. In addition, the manuals of the WRAT IV and the

WRIT report significant moderate to high correlations between their subtests and those of the

WIAT II and WAIS III that were used with the dyslexic group, thus demonstrating acceptable

convergent validity. On these grounds, we carried out direct between-group comparisons;

nevertheless, the results are indicative only. Performances were compared by multivariate

analysis of variance (MANOVA), followed up with univariate analyses (ANOVA) with

Bonferroni-adjusted alpha level, where group was the independent variable and background

measures were the dependent variables. This analysis included a smaller sample size for the

dyslexic group (n = 97) due to some missing data from the other 96 participants, which

resulted from differences in the number of tests used by different assessors (EPs) during the

full assessment procedure. Importantly, across all key measures (i.e., all background

measures, DAST measures, and BDT scores), the mean scores of the dyslexic subgroups (in
and out of the MANOVA) did not differ statistically. The data were first checked for outliers

(by group) and scores above or below 2.5 standard deviations from the mean were trimmed to

2.5 standard deviations. This affected one control participant on the spelling task and for one

dyslexic participant on the reading and spelling tasks, respectively. The MANOVA

assumption of equality of error variances was violated; therefore, a more conservative alpha

of .01 was used for significance (Tabachnick & Fidell, 2007).

A significant multivariate difference emerged between the groups F(5, 131) = 27.47,

p < .001; V = 0.51 (see descriptives in Table 4). A follow-up ANOVA (with

Bonferroni adjusted alpha of .01) revealed significant differences on all the measures except

verbal ability, F(1, 135) = 5.26, p = .023. Overall, the dyslexic group performed less well

than the control group, however, all scores were well within the average range, as would be

expected with a population of university students. On the literacy measures, the effect sizes

for reading accuracy and spelling were very large, respectively d = 1.86 and d = 1.59. We

remind the reader that the exact magnitudes of these effects should be interpreted with some

caution in light of the different standardized batteries used between groups. It is also notable

in Table 4 that on both DAST measures, the group with dyslexia was clearly in the ‘at risk’

range. In the aggregate, the students with dyslexia experienced significant literacy difficulties

relative to their own cognitive abilities and, in all likelihood, relative to those of the control

group.
Table 4

Mean Standard Scores (Standard Deviation in Parenthesis) on Background Measures of

Dyslexic and Control Groups, and Scores on DAST Nonsense Passage Reading and Two
Minute Spelling Subtests of Dyslexic Group

Measures Dyslexics Controls Cohen’s d

(n = 97) (n = 40)
Nonverbal Ability 103.04 (13.44)a 110.20 (8.89)b 0.64

Verbal Ability 105.44 (12.28)c 110.40 (8.93)d 0.47

Reading 95.94 (10.75) 114.83 (9.57) 1.86

Spelling 94.67 (12.68) 114.73 (12.59) 1.59

Comprehension 95.94 (13.93) 105.68 (8.18) 0.88

DAST Nonsense Passage 74.26 (12.91)e - -

Reading
DAST Two Minute Spelling 25.40 (4.60)f - -

Note. For the dyslexic group literacy was assessed with one of the following: WIAT II,
WRAT III, or WORD. For the control group literacy was assessed with the WRAT IV.
a
Score derived from Block Design subtest of the WAIS III.
b
Score derived from Matrices subtest of the WRIT.
c
Score derived from Vocabulary subtest of the WAIS III.
d
Score derived from Vocabulary subtest of the WRIT.
e
Scores below 87 indicate a risk of dyslexia.
f
Scores below 33 indicate a risk of dyslexia.

To assess whether the indicative group difference on nonverbal ability may have

confounded performance on the literacy measures, additional analyses of covariance,

controlling for nonverbal IQ, were conducted, and revealed that group differences on the

literacy tasks remained significant (Reading F(1, 160) = 67.24 p <.001, Spelling F(1, 160) =

52.51 p <.001, Comprehension F(1, 134) = 11.42 p =.001). These results are consistent with

the growing evidence suggesting that IQ is not a critical correlate of literacy abilities in adults

with dyslexia (Ferrer, Shaywitz, Holahan, Marchione, & Shaywitz, 2010).

We also considered the potential influences of age, gender, and language background

on the background measure attainments. As reported earlier, the groups differed significantly
in age, the controls being younger than the dyslexics. As age is factored into the scoring for

the standardised background measures, it is unlikely to have affected those results. The

number of females in our samples exceeded that of males (reflecting the gender

demographics of the academic colleges of the participants), however, no effects of gender

were found, with the exception of verbal ability where females, somewhat unexpectedly, had

lower attainments M = 105.76 SD = 11.59, than males M= 112.70 SD = 11.85, t(162) = -3.42,

p = .001. Across samples, 9% of participants had a first language other than English (8%

Welsh, 1% other), and we explored whether language status affected performance. T-tests

revealed all performances to be within the normal range, and importantly no differences on

the BDT, spelling, or comprehension. Some differences in favour of English L1 speakers

emerged on reading (t(32.01) = 3.99, p < .001), verbal t(159) = 3.42, p = .001) and nonverbal

abilities (t(159) = 2.72, p = .007). However, the very large difference in the language group

sizes (see Table 2) precludes any meaningful interpretation of these results.

Main Data Analysis

In the ensuing sections, we report analyses testing the reliability and validity of the

BDT. Participants’ total BDT scores were first checked for outliers (by group) and scores

above or below 2.5 standard deviations from the mean were adjusted to 2.5 standard

deviations. This led to two adjustments in the group with dyslexia. Next, we conducted an

analysis of the BDT’s internal consistency reliability using Cronbach’s Alpha. Then, to assess

the capacity of the BDT to discriminate between adults with and without dyslexia, the groups

were compared on each subtest using Mann Whitney U, as the scores were not normally

distributed; furthermore, the magnitude of any group difference on the battery as a whole was

tested by a t-test with Cohen’s d. Construct validity (convergent and divergent) was assessed

with correlational analysis. Finally, to assess predictive validity, we conducted a logistic

regression with the BDT total scores as predictor and group membership (dyslexic, control)

as the dependent variable.

Reliability of the BDT

Internal consistency of the BDT. We estimated the internal consistency of the

measure as a whole, as well as each of its subtests with Cronbach’s coefficient alpha, based

on the total sample of dyslexic and control participants (N = 233). The resulting overall

coefficient α = .72 indicated that the subtests are consistent and are likely measuring the same

underlying construct (see Table 5). Although adequate, its reliability is lower than what is

considered ideal (i.e., α  .80) (Field, 2009; Kline, 2000). The inter-item correlations of the

subtests ranged from a low of r = .16 to a high of r = .47 with mean of r = .20, reflecting their

heterogeneity. Item-total correlations ranged from .18 to .55 with Months Forwards and

Tables having the lowest and highest correlations, respectively. With the exception of Months

Forwards and Polysyllabic Words, the item-total correlations of all other subtests, were

greater than .30 indicating that they contributed to the reliability of the measure (Field, 2009).

The low correlation of the Months Forwards subtest, coupled with ceiling scores (see also

ensuing analyses), indicated that it was not contributing to the reliability of the screener and

is insensitive for this age group. The squared multiple correlations indicated that the Tables

subtest made the greatest contribution to the internal consistency of the BDT (R2 = .39), while

the Months Forwards and Polysyllabic Words subtests, not surprisingly, contributed the least

(R2 = .14). The Cronbach’s alpha-if-item-deleted figures indicated that the reliability of the

measure could not be improved by deleting any of the subtests. However, deleting the

Months Forwards and Polysyllabic Words subtests left alpha unchanged, revealing the

redundancy of these subtests, at least for use with adults. Thus, with the exception of Months

Forwards and Polysyllabic Words, all subtests were contributing to the BDT’s reliability.
Table 5

Item-total Statistics for BDT Subtests (N = 233)

Corrected item- Squared multiple Cronbach’s alpha

BDT Subtests total correlation correlation if item deleted
Left-right .32 .15 .71
Polysyllabic Words .27 .14 .72
Subtraction .51 .32 .67
Tables .55 .39 .67
Months Forwards .18 .14 .72
Months Reversed .36 .22 .70
Digits Forwards .38 .23 .70
Digits Reversed .43 .26 .69
B-D Confusion .36 .20 .70
Familial Incidence .43 .25 .69

Validation of the BDT

Comparison of performance of dyslexic and control groups on the BDT.

Given the age difference between the groups, we correlated age with BDT scores,

using the pooled sample (N = 233). This yielded a low but significant correlation with the

total score, r(233) = .13, p = .044, and similarly so for two of the subtests, B-D Confusion

r(233) = .14, p = .037, and Familial Incidence r(233) = .14, p = .040. However, these dropped

to non-significance when analysed within groups, suggesting that the foregoing significant

correlations were likely due to the group differences and not a specific association between

age and BDT scores.

The total dyslexic sample, n = 193, was included in ensuing group comparisons on the

BDT. We hypothesized a priory that the dyslexics would perform less well than the controls

on the BDT, obtaining higher total and individual subtest scores. Indeed, the dyslexics (M =
6.17, SD = 1.44) attained significantly higher (total BDT) index scores than the controls (M =

2.09, SD = 1.23), t(231) -16.69, p < .001. Moreover, this pattern was replicated on each

subtest (see details in Table 6). For the total measure, Cohen’s d = 3.06, indicated that the

difference was very large. The effect sizes for most subtests were also large, ranging from d =

0.87 for Digits Forwards to d = 1.70 on the Subtraction and Familial Incidence subtests. No

effect size was calculated for the Months Forwards and B-D Confusion subtests as the control

group performed at ceiling on these. The control group also performed near ceiling on the

Polysyllabic Words, Subtraction, Months Reversed, and Familial Incidence subtests.

Table 6

Results of Mann-Whitney U Test of Difference in Mean Ranks of Performance of Dyslexic and Control Groups on the BDT
Subtests, and Effect Sizes (N = 233)

Dyslexics Controls
(n = 193) (n = 40)
BDT Subtests Mean Rank Mean score Mean Rank Mean score Mann-Whitney U Z Cohen’s d
(SD) (SD)
Left/Right 125.88 .76 (.33) 74.16 .45 (.37) 2146.50 -4.94*** 0.89
Polysyllabic Words 126.20 .47 (.41) 72.63 .13 (.22) 2085.00 -4.90*** 1.08
Subtraction 128.79 .49 (.43) 60.10 .03 (.11) 1584.00 -6.35*** 1.70
Tables 128.25 .85 (.30) 62.73 .41 (.41) 1689.00 -6.76*** 1.24
Months Forwards 119.38 .08 (.22) 105.5 .00 (.00) 3400.00 -2.29* -
Months Reversed 125.81 .43 (.43) 74.48 .09 (.22) 2159.00 -4.79*** 1.03
Digits Forwards 124.38 .85 (.35) 81.41 .48 (.50) 2436.50 -5.00*** 0.87
Digits Reversed 126.86 .83 (.35) 69.43 .35 (.48) 1957.00 -6.16*** 1.16
B-D Confusion 131.20 .64 (.44) 48.50 .00 (.00) 1120.00 -7.80*** -
Familial Incidence 130.60 .77 (.37) 51.38 .15 (.36) 1235.00 -7.73*** 1.70
* p < .05. *** p < .001.
To better understand the nature of the between-group differences, the percentage of

participants in each group who obtained BDT scores respectively of: 1 (i.e., positive

indicator, at risk), 0 (i.e., negative indictor, not at risk), and .5 (i.e., marginal, doubtful) was

also examined (Table 7). Overall, the percentage obtaining positive scores was higher for the

dyslexic than the control group. In fact, no control participant obtained a positive score on

four subtests: Polysyllabic Words, Subtraction, Months Forwards and B-D Confusion. In

contrast, the dyslexic group obtained positive scores on all the subtests. For both groups, the

highest percentages of participants having positive scores occurred on Digits Forwards,

Digits Reversed, and Tables; however, the percentages were two to three times higher among

the dyslexic participants. Furthermore, the majority (68.9%) of dyslexic participants reported

that other members of their family might be affected by similar difficulties compared to

14.5% for the controls. Although the nature of their family relationships was not probed, this

result is broadly in line with research confirming increased risk of dyslexia for individuals

with first-order family members having the disorder (Byrne et al., 2009; Snowling, et al.,

2007). Generally, the performance of the control group indicated minimal difficulty with the

BDT, while the opposite was true for the dyslexic group.
Table 7

Percentages of Dyslexic and Control Participants Falling in each of the Outcome Categories
of the Subtests of the BDT (N = 233)

Outcome Categories
Subtests Positivea Marginalb Negativec
Dyslexics
Left-Right 61.7 29.0 9.3
Polysyllabic Words 31.1 32.1 36.8
Subtraction 35.8 26.4 37.8
Tables 76.2 17.1 6.7
Months Forwards 3.1 8.8 88.1
Months Reversed 30.1 25.9 44.0
Digits Forwards 82.9 3.6 13.5
Digits Reversed 78.2 9.3 12.5
B-D Confusion 57.5 13.5 29.0
Familial Incidence 68.9 16.6 14.5
Controls
Left-Right 22.5 45.0 32.5
Polysyllabic Words 0.0 25.0 75.0
Subtraction 0.0 5.0 95.0
Tables 25.0 32.5 42.5
Months Forwards 0.0 0.0 100.0
Months Reversed 2.5 12.5 85.0
Digits Forwards 47.5 2.5 50.0
Digits Reversed 35.0 0.0 65.0
B-D Confusion 0.0 0.0 100.0
Familial Incidence 15.0 0.0 85.0
Note. Dyslexics n = 193. Controls n = 40.
a
Positive outcome indicates a dyslexia positive response.
b
Marginal outcome indicates an ambiguous response not clearly dyslexia positive or
negative.
c
Negative outcome indicates a dyslexia negative response.
Despite the group differences, there were also some similarities. Both groups obtained

the highest number of positive indicators on the Digits Forwards, followed by Digits

Reversed and Tables subtests. In addition, both groups had the lowest mean scores and the

lowest percentage of plus scores on the Months Forwards subtest. Notwithstanding these

similarities, the Mann-Whitney U analysis indicated that dyslexics consistently obtained

significantly higher index scores than the controls.

Convergent and Divergent Validity. The convergent validity of the BDT was

examined by correlating the BDT total scores with the standardised measures of literacy for

the dyslexic and control samples separately and collectively, and the subtests of the DAST in

the dyslexia group (see Table 8). For the groups combined, significant negative correlations

obtained, with high scores on the BDT associated with lower scores on the other measures.

However, some of these correlations reflected range effects, and they reduced (sometimes to

nonsignificance) when considered separately within groups. Moreover, within the group with

dyslexia, the associations between the BDT and the timed DAST measures were relatively

stronger than those with the untimed standardized literacy tests, suggesting that by adulthood,

timed measures provide a more sensitive literacy assessment even among those with dyslexia.

Importantly, the correlations of the dyslexic group indicate that, although the BDT does not

directly assess literacy skills, poorer performance on the BDT is associated with literacy

difficulties, further supporting the construct validity of the screener. Divergent validity can

also be inferred. In the group with dyslexia, the correlation between nonverbal ability and the

BDT was not significant; this is again consistent with the view that among dyslexic adults,

the association between (nonverbal) IQ and literacy (and related skills) tends to decouple

(Ferrer et al., 2010). In contrast, among control participants, the only significant association

was obtained between nonverbal abilities and the BDT (the remaining correlations with IQ

ranging r = .04 to .08).

Table 8

Correlations between BDT, Standardized Measures of Literacy and Cognitive Skills, and the
DAST for Each Group Separately and Combined

Group Nonverbal Verbal Reading Spelling Compre- DAST DAST 2-

Abilitya Abilityb hension Nonsense Minute
Passage Spellingd
Readingc
Dyslexic -.14 -.22* -.23** -.26** -.26** -.30** -.33**
Control -.39* -.26 -.11 -.27 -.01 -- --
Combined -.27** -.24** -.55** -.55** -.39** -- --
Note. For the dyslexic group literacy was assessed with one of the following: WIAT II,
WRAT III, or WORD. For the control group literacy was assessed with the WRAT IV.
a
Scores derived from Block Design subtest of the WAIS III for the dyslexic group and the Matrices
subtest of the WRIT for the control group.
b
Scores derived from Vocabulary subtest of the WAIS III for the dyslexic group and the
Matrices subtest of the WRIT for the control group.
e
Only the dyslexic group is included in this correlation n = 191.
d
Only the dyslexic group is included in this correlation n = 192.
* p < .05. ** p < .01.

Predictive Validity. Logistic regression analysis was conducted to evaluate the

predictive validity of the BDT. Here, the total score obtained on the BDT was the predictor

and group membership (dyslexic or control) the dependent variable. Scores on the individual

subtests (categorical variables) were not used as predictors because the ratio of cases to

predictors was inadequate (Tabachnik & Fidell, 2007). The model was statistically significant

χ2 (1, N = 233) = 147.34, p < .001, indicating that the BDT score distinguished between the

dyslexic and control participants, and it explained a large amount of variance in the groups

.47 (Cox and Snell R2) and .78 (Nagelkerke R2). Also, the Hosmer-Lemeshow Goodness of

Fit Test indicated that the model fitted the data well χ2 (8, N = 233) = 4.15, p = .843. As

detailed in Table 9, overall, the BDT correctly classified 94% of the participants with an

excellent sensitivity rate of 96.4% and a specificity rate of 82.5%. Its positive predictive and

negative predictive values were the same as its sensitivity and specificity rates, respectively.
The BDT’s sensitivity rate was above the 80% minimum recommended, however, its

specificity rate was lower than the 90% minimum recommend by Glascoe and Byrne (1993).

Despite the less than ideal specificity, the BDT’s overall ability to discriminate between adult

dyslexics and non-dyslexics is clearly very good.

Table 9

Classification Results of the Logistic Regression for Dyslexics and Controls Groups

Participants Predicted Group Membership

Dyslexics Controls % Correct
Dyslexics 186 7 96.4
Controls 7 33 82.5
Overall % 94.0

An examination of the BDT scores of the 14 misclassified participants (7 dyslexics

and 7 controls, see Table 9) revealed that these individuals’ scores deviated considerably

from the mean scores of their respective groups. The BDT scores of the dyslexic participants

classified as controls (false negatives) ranged from 2.5 to 3, being much lower than the mean

score, 6.17, of the dyslexic group and outside its average variance SD = 1.44. The opposite

pattern held for the misclassified control participants (false positives) whose scores ranged

from 3.5 to 5, well above the mean of 2.09 and outside the average variance, SD = 1.23, of

this group. The atypical scores of these 14 participants raised the possibility that setting a cut-

off point for identifying at-risk individuals may help to improve the specificity rate

(proportion of individuals without dyslexia correctly classified) of the BDT while not

adversely affecting its sensitivity rate (proportion of individuals with dyslexia correctly

classified). Importantly, a threshold score of 4 as the minimum for a positive indication of

risk (as suggested by Miles (1997) for research purposes) would have increased the
specificity rate from 82.5% to 92.5%, which is above the minimum recommended (Glascoe

& Byrne, 1993). This cut-off could also be used for general screening purposes.

However, as is the case with all screening tools, misclassification can only be

minimized and not totally eliminated and this is especially true for individuals who perform

outside the norm. For example, of the 37 students who were screened at risk but not

diagnosed with dyslexia on full assessment (Table 1, column 1), 28 (75.7%) obtained scores

above 4 on the BDT, although their mean score of M = 5.46 (SD = 2.22) was lower than that

of the confirmed dyslexic group. Moreover, all but four of these participants were later

diagnosed with other specific learning disorders, which often co-occur with dyslexia and

share some behavioural features (Table 1); only 2% of the 37 were found to have no learning

difficulties.

We further examined the predictive validity of the BDT in an additional logistic

regression that included, in the group with dyslexia, only those participants (n = 183) whose

screening result specifically stated a risk of dyslexia (see Table 1). Here again, the total score

obtained on the BDT was the predictor and group membership the dependent variable. For

this analysis, the overall classification increased to 95.5%, with increased sensitivity 98.4%

while the specificity 82.5% remained the same.

Together, the foregoing analyses provided empirical evidence of the construct

(convergent and divergent) validity of the BDT. Its scores correlated more strongly with

literacy than with other cognitive measures. Additionally, predictive validity was

demonstrated as BDT scores predicted of group membership, and literacy performance.

Discussion

The main purpose of this study was to evaluate the BDT by examining its

psychometric properties, especially its ability to discriminate between adult students with and

without dyslexia. We used data from a large university sample of 193 students diagnosed

with dyslexia (dyslexic group), and 40 with no history of literacy difficulties (control group).

The cognitive profiles of the groups were in the average to above average range on

standardised tests of ability and literacy. However, with the exception of the measure of

verbal ability, where the groups were comparable, the controls attained significantly higher

scores than the dyslexics, and this most notably on measures of reading (d = 1.86) and

spelling (d = 1.59).

Reliability

The reliability analysis indicated that the internal consistency of the BDT (α = .72) is

adequate, but not optimal (Field, 2009; Kline, 2000). Thus, although the items on the BDT

are consistent and are likely measuring the same underlying construct, the magnitude of the

coefficient alpha was probably affected by the heterogeneity of its subtests. The author of the

BDT believed dyslexia to be a syndrome with a distinctive pattern of symptoms/difficulties,

and the test was designed to reflect this heterogeneity.

The screener could usefully be shortened by omitting the Polysyllabic Words and the

Months Forwards subtests, as deleting them leaves alpha unchanged, this poor sensitivity

reflecting near-ceiling performances. Miles (1993) similarly found that on Months Forward,

only 10.4% of 48 dyslexic adults (of diverse educational and socioeconomic backgrounds)

obtained positive scores. In adult assessments, these subtests could certainly be replaced by

age-appropriate and sensitive measures of phonological processing speed, a skill that was not

assessed in the BDT. Nevertheless, the reliability of the BDT is comparable to that of the
DAST, which reports test-retest reliability for its subtests ranging from r = .64 to r = .93

(Fawcett & Nicolson, 1998), and with the York Adult Assessment-Revised (YAA-R), which

reports internal consistency reliability ranging from α = .53 to α = .81 on its subtests

(Warmington, Stothard, & Snowling, 2013).

Validity

As expected, dyslexic participants attained significantly higher index scores than the

control group on the subtests and total of the BDT, the effect sizes being very large. Similar

differences on the BDT were reported by Miles (1993) among boys aged 7 to 14 years with

and without dyslexia, where the dyslexics performed less well (obtained higher scores) than

both chronological and spelling age-matched controls. In our study of adults, 57.5% to 82.9%

of participants with dyslexia obtained positive dyslexia indices across subtests and their

performance contrasted greatly with that of the controls of whom only a minority obtained

positive scores (2.5% to 47.5% of participants). In addition, the correlations indicated that,

although the subtests of the BDT were created on the basis of observational evidence (and not

their psychometric properties), most demonstrated face and construct validity in keeping with

what is currently known about dyslexia, as a language-based disorder.

The overall capacity of the BDT to differentiate between adult students with and

without dyslexia, however, obscures the weakness of several subtests which clearly are less

appropriate for assessing adults. Both groups reached ceiling on the Months Forwards

subtest, and, relatively few dyslexic participants obtained positive scores on the subtests

Months Reversed (30.1%), Polysyllabic Words (31.1%), and Subtraction (35.8%). The latter

results suggest that these subtests might add relatively little value to the battery as a whole

(see reliability analysis); however, their inclusion in no way damaged the reliability of the

battery. Moreover, these basic tests may be useful with adults in certain non-university
settings, such as employment centres, and in work environments where literacy skills of the

work force may be relatively weak.

Further evidence of the capacity of the BDT to discriminate between students with

dyslexia and controls was provided by the main logistic regression analysis (p. 19-20), as

well as a follow-up analysis including only those participants obtaining a clear ‘at-risk of

dyslexia’ indication at screening (p. 21). The BDT correctly classified 94% of the

participants, an excellent hit rate. It also had an excellent sensitivity rate, correctly classifying

96.4% of the dyslexic group, well above the minimum recommended, 80% (Glascoe &

Byrne, 1993). This high sensitivity rate ensures that the number of false negatives is kept to a

minimum and that most adults who are at risk of dyslexia will be correctly identified. The

BDT also correctly classified 82.5% of the controls making its specificity rate lower than the

90% minimum recommended. This may result in a larger than acceptable proportion of non-

dyslexics being incorrectly identified as being at risk of dyslexia (false positives). We were

not able to investigate the causes of the weaker specificity in the present study, but expect

that the addition of measures of phonological processing speed, as well as of reading and

spelling efficiency would improve this aspect of the battery. Indeed, we are currently

developing these supplementary measures, with a view to assessing their potential positive

impacts on the screener.

On balance, the classification rate of the BDT compares favourably with other adult

dyslexia screening tests. The DAST manual reports a sensitivity rate of 93% and a specificity

rate of 100%; however, only 15 dyslexics were included in the validation study for that

battery (Fawcett & Nicolson, 1998). What is more, independent research has reported lower

rates for sensitivity (85%) and specificity (74%) for the DAST (Harrison & Nichols, 2005).

The sensitivity rate of the BDT also compares favourably with other adult dyslexia screening
tests, such as the Lucid Adult Dyslexia Screening Plus (91%), (Singleton et al., 2009), and

the YAA-R (80%), (Warmington et al., 2013). However, the specificity rate of the BDT is

lower than the rates reported for these tests, 90% and 97%, respectively. However, as shown

earlier, the specificity rate of the test could be improved by clearly stipulating a cut-off score

of 4 for classification decisions. This arguably makes the BDT a more effective screening

test. As such, the BDT provides an alternative to other currently available screeners with its

easily administered and scored measures of several distal markers of dyslexia, that may be

appropriate for use with both children and adults in a variety of settings, including the non-

academic.

Conclusion

Currently there is no gold standard dyslexia screening test for adults and there is a

need for more empirical evidence on the effectiveness of the tests that are in use. This study

provided empirical evidence that the BDT is a reliable and valid measure capable of

discriminating between dyslexic and non-dyslexic adults. The study also highlighted some

weaknesses or areas for improvement, and suggestions for how the measure may be

enhanced. The BDT has been used effectively to screen for dyslexia in children and adults for

almost three decades; it is affordable and relatively easily adapted and translated to other

languages. In view of the rising need for simple-yet-sensitive screening tools for use with

adults, the results of this study suggest that it deserves its place as a quick, engaging and

adequately sensitive dyslexia screener, which may be particularly suited for non-academic

settings of training and employment.

This paper is dedicated to the memory of Professor Tim R. Miles, founding editor of the

journal Dyslexia, and co-founder of the Bangor Dyslexia Unit (now the Miles Dyslexia

Centre).

Sponsors: Knowledge Economy Skills Scholarship

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