Developmental dysgraphia: An overview and framework for research

Developmental deficits in the acquisition of writing skills (developmental dysgraphias) are common and have significant consequences, yet these deficits have received relatively little attention from researchers. We offer a framework for studying developmental dysgraphias (including both spelling and handwriting deficits), arguing that research should be grounded in theories describing normal cognitive writing mechanisms and the acquisition of these mechanisms. We survey the current state of knowledge concerning developmental dysgraphia, discussing potential proximal and distal causes. One conclusion emerging from this discussion is that developmental writing deficits are diverse in their manifestations and causes. We suggest an agenda for research on developmental dysgraphia, and suggest that pursuing this agenda may contribute not only to a better understanding of developmental writing impairment, but also to a better understanding of normal writing mechanisms and their acquisition. Finally, we provide a brief introduction to the subsequent articles in this special issue on developmental dysgraphia.

Networks and Theories: The Place of Connectionism in Cognitive Science

This article considers how connectionist modeling can contribute to understanding of human cognition. J argue that connectionist networks should not be thought of as theories or simulations of theories, but may nevertheless contribute to the development of theories.

A Developmental Deficit in Localizing Objects from Vision

We describe a college student, A H, with a developmental deficit in determining the location of objects from vision The deficit is selective in that (a) localization from auditory or tactile information is intact, (b) A H reports the identity of mislocalized objects accurately, (c) visual localization errors preserve certain parameters of the target location, and (d) visual localization is severely impaired under certain stimulus conditions, but nearly intact under other conditions These results bear on the representation and processing of location information in the visual system, and also have implications for understanding developmental dyslexia

Frontolimbic Morphometric Abnormalities in Intermittent Explosive Disorder and Aggression

BACKGROUND

Converging evidence from neuroimaging studies suggests that impulsive aggression, the core behavior in the DSM-5 diagnosis intermittent explosive disorder (IED), is regulated by frontolimbic brain structures, particularly orbitofrontal cortex, ventral medial prefrontal cortex, anterior cingulate cortex, amygdala, insula, and uncus. Despite this evidence, no brain volumetric studies of IED have been reported as yet. This study was conducted to test the hypothesis that gray matter volume in frontolimbic brain structures of subjects with IED is lower than in healthy subjects and subjects with other psychiatric conditions.

METHODS

High-resolution magnetic resonance imaging scans using a three-dimensional magnetization-prepared rapid acquisition gradient-echo sequence were performed in 168 subjects (n = 53 healthy control subjects, n = 58 psychiatric controls, n = 57 subjects with IED). Imaging data were analyzed by voxel-based morphometry methods employing Statistical Parametric Mapping (SPM8) software.

RESULTS

Gray matter volume was found to be significantly lower in subjects with IED compared with healthy control subjects and psychiatric controls in orbitofrontal cortex, ventral medial prefrontal cortex, anterior cingulate cortex, amygdala, insula, and uncus. These differences were not due to various confounding factors or to comorbidity with other disorders previously reported to have reduced gray matter volume. Gray matter volume in these areas was significantly and inversely correlated with measures of aggression.

CONCLUSIONS

Reductions in the gray matter volume of frontolimbic structures may be a neuronal characteristic of impulsively aggressive individuals with DSM-5 IED. These data suggest an anatomic correlate accounting for functional deficits in social-emotional information processing in these individuals.

Morphometric analysis of amygdla and hippocampus shape in impulsively aggressive and healthy control subjects

BACKGROUND

Impulsive aggressive behavior is thought to be facilitated by activation of the limbic brain, particularly the amygdala and hippocampus., Functional imaging studies suggest abnormalities in limbic brain activity during emotional information processing in impulsively aggressive subjects with Intermittent Explosive Disorder (IED). It is not known if IED is associated with altered amygdala and hippocampus volume and shape.

METHODS

We examined the volume and shape of the amygdala-hippocampal complex, using morphometric analysis of high resolution structural 3T MR scans in healthy control (HC: n = 73) subjects without history of Axis I or II psychiatric conditions and in subjects with IED (n = 67).

RESULTS

While no volume differences were observed between HC and IED subjects, a significant level of morphometric deformation, suggestive of cell loss, in both amygdala and hippocampal structures was observed bilaterally in IED subjects. Analysis of a canonical variable that used the first 10 eigenvectors from both sides of the brain revealed that these morphometric deformations in the IED subjects were not due the presence of confounding variables or to comorbidities among IED subjects.

CONCLUSIONS

These data reveal that IED is associated with a significant loss of neurons in both the amygdala and hippocampus. These changes may play a role in the functional abnormalities observed in previous fMRI studies and in the pathophysiology of impulsive aggressive behavior.

Criminal Behavior and Repeat Violent Trauma: A Case-Control Study

INTRODUCTION

Repeat violent injury is common among young urban men and is increasingly a focus of trauma center-based injury prevention efforts. Though understanding risk factors for repeat violent injury may be critical in designing such interventions, this knowledge is limited. This study aims to determine which criminal behaviors, both before and after the initial trauma, predict repeat violent trauma. Gun, violent, and drug crimes are expected to increase risk of subsequent violent injury among victims of violence.

METHODS

A case-control design examined trauma registry and publicly available criminal data for all male patients aged <40 years presenting for violent trauma between April 2006 and December 2011 (N=1,142) to the sole Level 1 trauma center in a city with high rates of violence. Logistic regression was used to determine criminal behaviors predictive of repeat violent injury. Data were obtained and analyzed between January 2013 and June 2014.

RESULTS

Regarding crimes committed before the first injury, only drug crime (OR=5.32) predicted repeat violent trauma. With respect to crimes committed after the initial injury, illegal gun possession (OR=2.70) predicted repeat victimization. Initiating gun (OR=3.53) or drug crime (OR=5.12) was associated with increased risk.

CONCLUSIONS

Prior drug involvement may identify young male victims of violence as at high risk of repeat violent injury. Gun carrying and initiating drug involvement after the initial injury may increase risk of repeat injury and may be important targets for interventions aimed at preventing repeat violent trauma.

A deficit perceiving slow motion after brain damage and a parallel deficit induced by crowding

Motion perception is known to involve at least 2 kinds of mechanisms-lower level signal detectors and higher level algorithms for comparing object positions over time. When stimulus motion is modal (continuously visible), it is generally assumed that processing via lower level mechanisms is sufficient to make accurate motion judgments. We investigated the possibility that higher level mechanisms may also be involved in the processing of slow motion, even when it is smooth and continuous. This possibility was suggested by results from a brain-damaged patient, JKI, who showed left visual field deficits in both the explicit representation of object position and judgments concerning the direction of slow, but not fast, smooth motion. We investigated the possibility further by using crowding to induce a behaviorally similar motion-perception deficit in healthy observers. Crowding, which is known to impair object-position representation, impaired direction judgments for slow, but not for faster, smooth motion. The results suggest an everyday role for higher level mechanisms in the perception of slow motion, and they reinforce the taxonomy of motion perception in terms of underlying processing mechanisms as opposed to stimulus properties.

Severity of vision loss interacts with word-specific features to impact out-loud reading in glaucoma

PURPOSE

To assess the impact of glaucoma-related vision loss on measures of out-loud reading, including time to say individual words, interval time between consecutive words, lexical errors, skipped words, and repetitions.

METHODS

Glaucoma subjects (n = 63) with bilateral visual field loss and glaucoma suspect controls (n = 57) were recorded while reading a standardized passage out loud. A masked evaluator determined the start and end of each recorded word and identified reading errors.

RESULTS

Glaucoma subjects demonstrated longer durations to recite individual words (265 vs. 243 ms, P < 0.001), longer intervals between words (154 vs. 124 ms, P < 0.001), and longer word/post-word interval complexes (the time spanned by the word and the interval following the word; 419 vs. 367 ms, P < 0.001) than controls. In multivariable analyses, each 0.1 decrement in log contrast sensitivity (logCS) was associated with a 15.0 ms longer word/post-interval complex (95% confidence interval [CI] = 9.6-20.4; P < 0.001). Contrast sensitivity was found to significantly interact with word length, word frequency, and word location at the end of a line with regards to word/post-word interval complex duration (P < 0.05 for all). Glaucoma severity was also associated with more lexical errors (Odds ratio = 1.20 for every 0.1 logCS decrement; 95% CI = 1.02-1.39, P < 0.05), but not with more skipped or repeated words.

CONCLUSIONS

Glaucoma patients with greater vision loss make more lexical errors, are slower in reciting longer and less frequently used words, and more slowly transition to new lines of text. These problem areas may require special attention when designing methods to rehabilitate reading in patients with glaucoma.

Representation of item position in immediate serial recall: Evidence from intrusion errors

In immediate serial recall, participants are asked to recall novel sequences of items in the correct order. Theories of the representations and processes required for this task differ in how order information is maintained; some have argued that order is represented through item-to-item associations, while others have argued that each item is coded for its position in a sequence, with position being defined either by distance from the start of the sequence, or by distance from both the start and the end of the sequence. Previous researchers have used error analyses to adjudicate between these different proposals. However, these previous attempts have not allowed researchers to examine the full set of alternative proposals. In the current study, we analyzed errors produced in 2 immediate serial recall experiments that differ in the modality of input (visual vs. aural presentation of words) and the modality of output (typed vs. spoken responses), using new analysis methods that allow for a greater number of alternative hypotheses to be considered. We find evidence that sequence positions are represented relative to both the start and the end of the sequence, and show a contribution of the end-based representation beyond the final item in the sequence. We also find limited evidence for item-to-item associations, suggesting that both a start-end positional scheme and item-to-item associations play a role in representing item order in immediate serial recall.

Severity of Vision Loss Interacts with Word-Specific Features to Impact Out-Loud Reading in Glaucoma

Purpose: To assess the impact of glaucoma-related vision loss on measures of out-loud reading, including time to say individual words, interval time between consecutive words, lexical errors, skipped words, and repetitions. Methods: Glaucoma subjects (n=63) with bilateral visual field loss and glaucoma suspect controls (n=57) were recorded while reading a standardized passage out loud. A masked evaluator determined the start and end of each recorded word and identified reading errors. Results: Glaucoma subjects demonstrated longer durations to recite individual words (265 vs 243 milliseconds (ms), p<0.001), longer intervals between words (154 vs 124 ms, p<0.001), and longer word/post-word interval complexes (the time spanned by the word and the interval following the word) (419 vs. 367 ms, p<0.001) than controls. In multivariable analyses, each 0.1 decrement in log contrast sensitivity (logCS) was associated with a 15.0 ms longer word/post-interval complex (95% CI=9.6-20.4; p<0.001). Contrast sensitivity was found to significantly interact with word length, word frequency, and word location at the end of a line with regards to word/post-word interval complex duration (p<0.05 for all). Glaucoma severity was also associated with more lexical errors (Odds ratio=1.20 for every 0.1 logCS decrement; 95% CI=1.02-1.39, p<0.05), but not with more skipped or repeated words. Conclusions: Glaucoma patients with greater vision loss make more lexical errors, are slower in reciting longer and less frequently used words, and more slowly transition to new lines of text. These problem areas may require special attention when designing methods to rehabilitate reading in patients with glaucoma.

Somatotopic representation of location: evidence from the Simon effect

Representing the locations of tactile stimulation can involve somatotopic reference frames in which locations are defined relative to a position on the skin surface, and also external reference frames that take into account stimulus position in external space. Locations in somatotopic and external reference frames can conflict in terms of left/right assignment when the hands are crossed or positioned outside of their typical hemispace. To investigate the spatial codes of the representation of both tactile stimuli and responses to touch, a Simon effect task, often used in the visual modality to examine issues of spatial reference frames, was deployed in the tactile modality. Participants performed the task with stimuli delivered to the hands with arms in crossed or uncrossed postures and responses were produced with foot pedals. Across all 4 experiments, participants were faster on somatotopically congruent trials (e.g., left hand stimulus, left foot response) than on somatotopically incongruent trials (left hand stimulus, right foot response), regardless of arm or leg position. However, some evidence of an externally based Simon effect also appeared in 1 experiment in which arm (stimulus) and leg (response) position were both manipulated. Overall, the results demonstrate that tactile stimulus and response codes are primarily generated based on their somatotopic identity. However, stimulus and response coding based on an external reference frame can become more salient when both hands and feet can be crossed, creating a situation in which somatotopic and external representations can differ for both stimulus and response codes.

New learning of music after bilateral medial temporal lobe damage: evidence from an amnesic patient

Damage to the hippocampus impairs the ability to acquire new declarative memories, but not the ability to learn simple motor tasks. An unresolved question is whether hippocampal damage affects learning for music performance, which requires motor processes, but in a cognitively complex context. We studied learning of novel musical pieces by sight-reading in a newly identified amnesic, LSJ, who was a skilled amateur violist prior to contracting herpes simplex encephalitis. LSJ has suffered virtually complete destruction of the hippocampus bilaterally, as well as extensive damage to other medial temporal lobe structures and the left anterior temporal lobe. Because of LSJ's rare combination of musical training and near-complete hippocampal destruction, her case provides a unique opportunity to investigate the role of the hippocampus for complex motor learning processes specifically related to music performance. Three novel pieces of viola music were composed and closely matched for factors contributing to a piece's musical complexity. LSJ practiced playing two of the pieces, one in each of the two sessions during the same day. Relative to a third unpracticed control piece, LSJ showed significant pre- to post-training improvement for the two practiced pieces. Learning effects were observed both with detailed analyses of correctly played notes, and with subjective whole-piece performance evaluations by string instrument players. The learning effects were evident immediately after practice and 14 days later. The observed learning stands in sharp contrast to LSJ's complete lack of awareness that the same pieces were being presented repeatedly, and to the profound impairments she exhibits in other learning tasks. Although learning in simple motor tasks has been previously observed in amnesic patients, our results demonstrate that non-hippocampal structures can support complex learning of novel musical sequences for music performance.

Profound loss of general knowledge in retrograde amnesia: evidence from an amnesic artist

Studies of retrograde amnesia have focused on autobiographical memory, with fewer studies examining how non-autobiographical memory is affected. Those that have done so have focused primarily on memory for famous people and public events—relatively limited aspects of memory that are tied to learning during specific times of life and do not deeply tap into the rich and extensive knowledge structures that are developed over a lifetime. To assess whether retrograde amnesia can also cause impairments to other forms of general world knowledge, we explored losses across a broad range of knowledge domains in a newly-identified amnesic. LSJ is a professional artist, amateur musician and history buff with extensive bilateral medial temporal and left anterior temporal damage. We examined LSJ's knowledge across a range of everyday domains (e.g., sports) and domains for which she had premorbid expertise (e.g., famous paintings). Across all domains tested, LSJ showed losses of knowledge at a level of breadth and depth never before documented in retrograde amnesia. These results show that retrograde amnesia can involve broad and deep deficits across a range of general world knowledge domains. Thus, losses that have already been well-documented (famous people and public events) may severely underestimate the nature of human knowledge impairment that can occur in retrograde amnesia.

Representation of letter position in single-word reading: evidence from acquired dyslexia

Visual word recognition requires information about the positions as well as the identities of the letters in a word. This study addresses representation of letter position at prelexical levels of the word recognition process. We present evidence from an acquired dyslexic patient, L.H.D., who perseverates letters in single-word reading tasks: Far more often than expected by chance, L.H.D.'s reading responses include letters from preceding responses (e.g., SAILOR read as SAILOG immediately after FLAG was read correctly). Analyses carried out over two large data sets compared the positions of perseverated letters (e.g., the G in SAILOG) with the positions of the corresponding "source" letters (e.g., the G in FLAG). The analyses assessed the extent to which the perseverations preserved source position as defined by various theories of letter position representation. The results provided strong evidence for graded both-edges position representations, in which the position of each letter is encoded coarsely relative to both the beginning and the end of the word. Alternative position representation schemes, including letter-context and orthosyllabic schemes, were not supported.

Prelexical representations and processes in reading: evidence from acquired dyslexia

We report a detailed and extensive single-case study of an acquired dyslexic patient, L.H.D., who suffered a left-hemisphere lesion as a result of a ruptured aneurysm. We present evidence that L.H.D.'s reading errors stem from a deficit in visual letter identification, and we use her deficit as a basis for exploring a variety of issues concerning prelexical representations and processes in reading. First, building on the work of other researchers, we present evidence that the prelexical reading system includes an allograph level of representation that represents each distinct visual shape of a letter (e.g., a, A, etc., for the letter A). We extend a theory proposed by Caramazza and Hillis [Caramazza, A., & Hillis, A. (1990a). Spatial representation of words in the brain implied by studies of a unilateral neglect patient. Nature, 346, 267-269] to include an allograph level, and we probe the nature of the allograph representations in some detail. Next, we explore the implications of visual similarity effects and letter perseverations in L.H.D.'s reading performance, arguing that these effects shed light on activation dynamics in the prelexical reading system and on the genesis of L.H.D.'s errors. We also probe the processing of letter case in the visual letter identification process, proposing that separate abstract letter identity and case representations are computed. Finally, we present evidence that the allograph level as well as the abstract letter identity level implement a word-based frame of reference.

The necessity of the medial temporal lobe for statistical learning

The sensory input that we experience is highly patterned, and we are experts at detecting these regularities. Although the extraction of such regularities, or statistical learning (SL), is typically viewed as a cortical process, recent studies have implicated the medial temporal lobe (MTL), including the hippocampus. These studies have employed fMRI, leaving open the possibility that the MTL is involved but not necessary for SL. Here, we examined this issue in a case study of LSJ, a patient with complete bilateral hippocampal loss and broader MTL damage. In Experiments 1 and 2, LSJ and matched control participants were passively exposed to a continuous sequence of shapes, syllables, scenes, or tones containing temporal regularities in the co-occurrence of items. In a subsequent test phase, the control groups exhibited reliable SL in all conditions, successfully discriminating regularities from recombinations of the same items into novel foil sequences. LSJ, however, exhibited no SL, failing to discriminate regularities from foils. Experiment 3 ruled out more general explanations for this failure, such as inattention during exposure or difficulty following test instructions, by showing that LSJ could discriminate which individual items had been exposed. These findings provide converging support for the importance of the MTL in extracting temporal regularities.