Poor reading comprehension despite fast word decoding in children with hydrocephalus

Children with hydrocephalus decode words better than they understand what they read. We tested whether children with hydrocephalus (from myelomeningocele or aqueduct stenosis) (1) decode words slowly, (2) use decoding processes similar to those of neurologically intact peers, and (3) comprehend poorly to the extent that they are slow decoders. We compared speed of word decoding in 33 children with hydrocephalus and 33 controls matched on a pairwise basis for age, grade, and word decoding accuracy. The children with hydrocephalus were as fast as controls in reading words, but, unlike controls, they did not demonstrate an effect of spelling-sound regularity. Further, decoding speed did not contribute to reading comprehension beyond word decoding accuracy. The reading comprehension deficits of good decoders with hydrocephalus are not related to early-stage processing deficits in word recognition speed. Likely origins of comprehension failure in this group are discussed.