Neural changes following remediation in adult developmental dyslexia

Evidence for reading improvement following tDCS treatment in children and adolescents with Dyslexia

PURPOSE

There is evidence that non-invasive brain stimulation transitorily modulates reading by facilitating the neural pathways underactive in individuals with dyslexia. The study aimed at investigating whether multiple sessions of transcranial direct current stimulation (tDCS) would enhance reading abilities of children and adolescents with dyslexia and whether the effect is long-lasting.

METHODS

Eighteen children and adolescents with dyslexia received three 20-minute sessions a week for 6 weeks (18 sessions) of left anodal/right cathodal tDCS set at 1 mA over parieto-temporal regions combined with a cognitive training. The participants were randomly assigned to the active or the sham treatment; reading tasks (text, high and low frequency words, non-words) were used as outcome measures and collected before treatment, after treatment and one month after the end of treatment. The tolerability of tDCS was evaluated.

RESULTS

The active group showed reduced low frequency word reading errors and non-word reading times. These positive effects were stable even one month after the end of treatment. None reported adverse effects.

CONCLUSIONS

The study shows preliminary evidence of tDCS feasibility and efficacy in improving non-words and low frequency words reading of children and adolescents with dyslexia and it opens new rehabilitative perspectives for the remediation of dyslexia.

Network dynamics in dyslexia: Review and implications for remediation

Extant neurobiological theories of dyslexia appear fractional in focusing on isolated brain regions, mechanisms, and functional pathways. A synthesis of current research shows support for an Interactive Specialization (IS) model of dyslexia involving the dysfunctional orchestration of a widely-distributed, attentionally-controlled, hierarchical, and interhemispheric circuit of intercommunicating neuronal networks. This circuitry is comprised principally of the frontostriatal-parietal cognitive control system of networks, the posterior corpus callosum, and the left arcuate fasciculus. During development, the coalescence of these functionally specialized regions, acting together, may be essential to preventing the core phonemic and phonological processing deficits defining the dyslexic phenotype. Research demonstrating an association of each with processing phonology presents the foundational outline for a comprehensive, integrative theory of dyslexia and suggests the importance of inclusive remedial efforts aimed at promoting interactions among all three networking territories.

Impact of Intensive Summer Reading Intervention for Children With Reading Disabilities and Difficulties in Early Elementary School

Efficacy of an intensive reading intervention implemented during the nonacademic summer was evaluated in children with reading disabilities or difficulties (RD). Students (ages 6-9) were randomly assigned to receive Lindamood-Bell's Seeing Stars program ( n = 23) as an intervention or to a waiting-list control group ( n = 24). Analysis of pre- and posttesting revealed significant interactions in favor of the intervention group for untimed word and pseudoword reading, timed pseudoword reading, oral reading fluency, and symbol imagery. The interactions mostly reflected (a) significant declines in the nonintervention group from pre- to posttesting, and (2) no decline in the intervention group. The current study offers direct evidence for widening differences in reading abilities between students with RD who do and do not receive intensive summer reading instruction. Intervention implications for RD children are discussed, especially in relation to the relevance of summer intervention to prevent further decline in struggling early readers.

Weighing the Cost and Benefit of Transcranial Direct Current Stimulation on Different Reading Subskills

Adults struggling with low reading skills are underserved by limited available treatments. While brain stimulation techniques such as transcranial direct current stimulation (tDCS) has the potential to improve a variety of cognitive functions, little work has been done examining its potential to treat reading disabilities. Research on the effects of tDCS on reading abilities has been somewhat inconsistent perhaps in part due to discrepancies between studies in the nature of the tasks. In the current study, we examined the effect of tDCS to the left inferior parietal lobe (L IPL) on two reading tasks in low-to-average readers. We compared performance on a sight word efficiency (SWE) task and a rhyme judgment task before and after either stimulation to the L IPL, right superior parietal lobe (R SPL), or sham stimulation. Readers who received stimulation to the L IPL showed greater improvements on the SWE task, but less improvement on the rhyme judgment task compared to the R SPL and sham groups. This study demonstrates for the first time both a positive and negative effect of stimulation under the same stimulation parameters within the same participants. The results highlight the need to consider multiple tasks when assessing the potential of using tDCS as a treatment.

Imaging the "At-Risk" Brain: Future Directions

OBJECTIVES

Clinical neuroscience is increasingly turning to imaging the human brain for answers to a range of questions and challenges. To date, the majority of studies have focused on the neural basis of current psychiatric symptoms, which can facilitate the identification of neurobiological markers for diagnosis. However, the increasing availability and feasibility of using imaging modalities, such as diffusion imaging and resting-state fMRI, enable longitudinal mapping of brain development. This shift in the field is opening the possibility of identifying predictive markers of risk or prognosis, and also represents a critical missing element for efforts to promote personalized or individualized medicine in psychiatry (i.e., stratified psychiatry).

METHODS

The present work provides a selective review of potentially high-yield populations for longitudinal examination with MRI, based upon our understanding of risk from epidemiologic studies and initial MRI findings.

RESULTS

Our discussion is organized into three topic areas: (1) practical considerations for establishing temporal precedence in psychiatric research; (2) readiness of the field for conducting longitudinal MRI, particularly for neurodevelopmental questions; and (3) illustrations of high-yield populations and time windows for examination that can be used to rapidly generate meaningful and useful data. Particular emphasis is placed on the implementation of time-appropriate, developmentally informed longitudinal designs, capable of facilitating the identification of biomarkers predictive of risk and prognosis.

CONCLUSIONS

Strategic longitudinal examination of the brain at-risk has the potential to bring the concepts of early intervention and prevention to psychiatry.

Developmental Learning Disorders: From Generic Interventions to Individualized Remediation

Developmental learning disorders affect many children, impairing their experience in the classroom and hindering many aspects of their life. Once a bleak sentence associated with life-long difficulties, several learning disorders can now be successfully alleviated, directly benefiting from promising interventions. In this review, we focus on two of the most prevalent learning disorders, dyslexia and attention-deficit/hyperactivity disorder (ADHD). Recent advances have refined our understanding of the specific neural networks that are altered in these disorders, yet questions remain regarding causal links between neural changes and behavioral improvements. After briefly reviewing the theoretical foundations of dyslexia and ADHD, we explore their distinct and shared characteristics, and discuss the comorbidity of the two disorders. We then examine current interventions, and consider the benefits of approaches that integrate remediation within other activities to encourage sustained motivation and improvements. Finally, we conclude with a reflection on the potential for remediation programs to be personalized by taking into account the specificities and demands of each individual. The effective remediation of learning disorders is critical to modern societies, especially considering the far-reaching ramifications of successful early interventions.

Language comprehension and brain function in individuals with an optimal outcome from autism

Although Autism Spectrum Disorder (ASD) is generally a lifelong disability, a minority of individuals with ASD overcome their symptoms to such a degree that they are generally indistinguishable from their typically-developing peers. That is, they have achieved an Optimal Outcome (OO). The question addressed by the current study is whether this normalized behavior reflects normalized brain functioning, or alternatively, the action of compensatory systems. Either possibility is plausible, as most participants with OO received years of intensive therapy that could alter brain networks to align with typical function or work around ASD-related neural dysfunction. Individuals ages 8 to 21 years with high-functioning ASD (n = 23), OO (n = 16), or typical development (TD; n = 20) completed a functional MRI scan while performing a sentence comprehension task. Results indicated similar activations in frontal and temporal regions (left middle frontal, left supramarginal, and right superior temporal gyri) and posterior cingulate in OO and ASD groups, where both differed from the TD group. Furthermore, the OO group showed heightened “compensatory” activation in numerous left- and right-lateralized regions (left precentral/postcentral gyri, right precentral gyrus, left inferior parietal lobule, right supramarginal gyrus, left superior temporal/parahippocampal gyrus, left middle occipital gyrus) and cerebellum, relative to both ASD and TD groups. Behaviorally normalized language abilities in OO individuals appear to utilize atypical brain networks, with increased recruitment of language-specific as well as right homologue and other systems. Early intensive learning and experience may normalize behavioral language performance in OO, but some brain regions involved in language processing may continue to display characteristics that are more similar to ASD than typical development, while others show characteristics not like ASD or typical development.

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fMRI study of "optimal outcome" (OO) youth with no symptoms of autism spectrum disorder.

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Results show “compensatory” language activation in some areas in OO.

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OO youth also had some “residual ASD” patterns of activation (OO, ASD > TD).

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There was no evidence of areas of normalized brain function (OO, TD ≠ ASD).

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Early treatment may normalize behavior but not brain in some individuals with ASD.

The contribution of phonological knowledge, memory, and language background to reading comprehension in deaf populations

While reading is challenging for many deaf individuals, some become proficient readers. Little is known about the component processes that support reading comprehension in these individuals. Speech-based phonological knowledge is one of the strongest predictors of reading comprehension in hearing individuals, yet its role in deaf readers is controversial. This could reflect the highly varied language backgrounds among deaf readers as well as the difficulty of disentangling the relative contribution of phonological versus orthographic knowledge of spoken language, in our case ‘English,’ in this population. Here we assessed the impact of language experience on reading comprehension in deaf readers by recruiting oral deaf individuals, who use spoken English as their primary mode of communication, and deaf native signers of American Sign Language. First, to address the contribution of spoken English phonological knowledge in deaf readers, we present novel tasks that evaluate phonological versus orthographic knowledge. Second, the impact of this knowledge, as well as memory measures that rely differentially on phonological (serial recall) and semantic (free recall) processing, on reading comprehension was evaluated. The best predictor of reading comprehension differed as a function of language experience, with free recall being a better predictor in deaf native signers than in oral deaf. In contrast, the measures of English phonological knowledge, independent of orthographic knowledge, best predicted reading comprehension in oral deaf individuals. These results suggest successful reading strategies differ across deaf readers as a function of their language experience, and highlight a possible alternative route to literacy in deaf native signers.

Highlights:

1. Deaf individuals vary in their orthographic and phonological knowledge of English as a function of their language experience.

2. Reading comprehension was best predicted by different factors in oral deaf and deaf native signers.

3. Free recall memory (primacy effect) better predicted reading comprehension in deaf native signers as compared to oral deaf or hearing individuals.

4. Language experience should be taken into account when considering cognitive processes that mediate reading in deaf individuals.

The direct segment of the arcuate fasciculus is predictive of longitudinal reading change

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We related arcuate subtract coherence to longitudinal reading outcomes in children.

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FA along the direct segment was uniquely predictive of reading growth.

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This effect was consistent in both younger and older children.

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Specifically the direct segment's structure may support reading across development.

Structural coherence across the arcuate fasciculus has previously been related to reading skill, but the arcuate may be divisible into distinct subtracts which support different functions. Here, we examine longitudinal data from 30 children between the ages of 8 and 14 to determine whether initial coherence in any of the arcuate's subsections is predictive of changes in reading across a longitudinal interval of approximately three years. The arcuate was divided using probabilistic tractography; mean fractional anisotropy across each subtract was extracted for each participant. Time 1 to Time 2 change in reading skill (identification, fluency score average) was significantly and uniquely predicted by only direct fronto-temporal arcuate segment coherence. Participants with lower direct segment FA demonstrated decreases in reading scores, potentially reflecting lessened improvements due to continued inefficient processing. These results were consistent in the older and younger halves of the sample. As such, we demonstrate that it is specifically the direct segment of the arcuate that may support and be predictive of reading skill both initially and longitudinally across development.

A compensatory role for declarative memory in neurodevelopmental disorders

Most research on neurodevelopmental disorders has focused on their abnormalities. However, what remains intact may also be important. Increasing evidence suggests that declarative memory, a critical learning and memory system in the brain, remains largely functional in a number of neurodevelopmental disorders. Because declarative memory remains functional in these disorders, and because it can learn and retain numerous types of information, functions, and tasks, this system should be able to play compensatory roles for multiple types of impairments across the disorders. Here, we examine this hypothesis for specific language impairment, dyslexia, autism spectrum disorder, Tourette syndrome, and obsessive-compulsive disorder. We lay out specific predictions for the hypothesis and review existing behavioral, electrophysiological, and neuroimaging evidence. Overall, the evidence suggests that declarative memory indeed plays compensatory roles for a range of impairments across all five disorders. Finally, we discuss diagnostic, therapeutic and other implications.

Greater functional connectivity between reading and error-detection regions following training with the reading acceleration program in children with reading difficulties

The Reading Acceleration Program is a computerized program that improves reading and the activation of the error-detection mechanism in individuals with reading difficulty (RD) and typical readers (TRs). The current study aims to find the neural correlates for this effect in English-speaking 8-12-year-old children with RD and TRs using a functional connectivity analysis. Functional magnetic resonance imaging data were collected during a lexical decision task before and after 4 weeks of training with the program, together with reading and executive functions measures. Results indicated improvement in reading, visual attention, and speed of processing in children with RD. Following training, greater functional connectivity was observed between the left fusiform gyrus and the right anterior cingulate cortex in children with RD and between the left fusiform gyrus and the left anterior cingulate cortex in TRs. The change in functional connectivity after training was correlated with increased behavioral scores for word reading and visual attention in both groups. The results support previous findings of improved monitoring and mental lexicon after training with the Reading Acceleration Program in children with RD and TRs. The differences in laterality of the anterior cingulate cortex in children with RD and the presumable role of the cingulo-opercular control network in language processing are discussed.

Thalamo-cortical connectivity: what can diffusion tractography tell us about reading difficulties in children?

Reading is an essential skill in modern society, but many people have deficits in the decoding and word recognition aspects of reading, a difficulty often referred to as dyslexia. The primary focus of neuroimaging studies to date in dyslexia has been on cortical regions; however, subcortical regions may also be important for explaining this disability. Here, we used diffusion tensor imaging to examine the association between thalamo-cortical connectivity and children's reading ability in 20 children with typically developed reading ability (age range 8-17/10-17 years old from two imaging centers) and 19 children with developmental dyslexia (DYS) (age range 9-17/9-16 years old). To measure thalamo-cortical connections, the structural images were segmented into cortical and subcortical anatomical regions that were used as target and seed regions in the probabilistic tractography analysis. Abnormal thalamic connectivity was found in the dyslexic group in the sensorimotor and lateral prefrontal cortices. These results suggest that the thalamus may play a key role in reading behavior by mediating the functions of task-specific cortical regions; such findings lay the foundation for future studies to investigate further neurobiological anomalies in the development of thalamo-cortical connectivity in DYS.

Effective connectivity of brain regions related to visual word recognition: An fMRI study of Chinese reading

Past neuroimaging studies have focused on identifying specialized functional brain systems for processing different components of reading, such as orthography, phonology, and semantics. More recently, a few experiments have been performed to look into the integration and interaction of distributed neural systems for visual word recognition, suggesting that lexical processing in alphabetic languages involves both ventral and dorsal neural pathways originating from the visual cortex. In the present functional magnetic resonance imaging study, we tested the multiple pathways model with Chinese character stimuli and examined how the neural systems interacted in reading Chinese. Using dynamic causal modeling, we demonstrated that visual word recognition in Chinese engages the ventral pathway from the visual cortex to the left ventral occipitotemporal cortex, but not the dorsal pathway from the visual cortex to the left parietal region. The ventral pathway, however, is linked to the superior parietal lobule and the left middle frontal gyrus (MFG) so that a dynamic neural network is formed, with information flowing from the visual cortex to the left ventral occipitotemporal cortex to the parietal lobule and then to the left MFG. The findings suggest that cortical dynamics is constrained by the differences in how visual orthographic symbols in writing systems are linked to spoken language.

A meta-analysis of functional reading systems in typically developing and struggling readers across different alphabetic languages

Functional neuroimaging research has identified multiple brain regions supporting reading-related activity in typical and atypical readers across different alphabetic languages. Previous meta-analyses performed on these functional magnetic resonance imaging findings typically report significant between-group contrasts comparing typical readers and readers with reading difficulty or a clinical diagnosis of developmental dyslexia. In order to advance our understanding of cross-linguistic convergence of reading-related brain activations for these reader groups, analyses using activation likelihood estimation were carried out separately for typical and atypical readers who ranged from children to adults. Contrasts were analyzed for tasks involving rhyming or reading of letter or word stimuli presented visually in English, Dutch, Italian, German, French, or Norwegian. Typical readers showed reliable activation in only left lateralized regions, including the inferior frontal area, precentral area and middle temporal gyrus. Atypical readers also showed activation in the left inferior frontal area and precentral region, in addition to significant activations in the right hemisphere, including the superior, medial and inferior frontal regions, lingual gyrus and the inferior occipital area. These results distinguish between typical and atypical reader group activations, showing common and distinct regions of activation when engaged in reading-related activities, extending previous meta-analyses on identifying brain regions relevant to reading to include cross-linguistic analyses for alphabetic scripts. Results support the universality of a signature pattern of brain activation in developmental dyslexia across alphabetic languages.

Neuroscience illuminating the influence of auditory or phonological intervention on language-related deficits

Remediation programs for language-related learning deficits are urgently needed to enable equal opportunities in education. To meet this need, different training and intervention programs have been developed. Here we review, from an educational perspective, studies that have explored the neural basis of behavioral changes induced by auditory or phonological training in dyslexia, specific language impairment (SLI), and language-learning impairment (LLI). Training has been shown to induce plastic changes in deficient neural networks. In dyslexia, these include, most consistently, increased or normalized activation of previously hypoactive inferior frontal and occipito-temporal areas. In SLI and LLI, studies have shown the strengthening of previously weak auditory brain responses as a result of training. The combination of behavioral and brain measures of remedial gains has potential to increase the understanding of the causes of language-related deficits, which may help to target remedial interventions more accurately to the core problem.

Cortical thickness abnormalities associated with dyslexia, independent of remediation status

Abnormalities in cortical structure are commonly observed in children with dyslexia in key regions of the "reading network." Whether alteration in cortical features reflects pathology inherent to dyslexia or environmental influence (e.g., impoverished reading experience) remains unclear. To address this question, we compared MRI-derived metrics of cortical thickness (CT), surface area (SA), gray matter volume (GMV), and their lateralization across three different groups of children with a historical diagnosis of dyslexia, who varied in current reading level. We compared three dyslexia subgroups with: (1) persistent reading and spelling impairment; (2) remediated reading impairment (normal reading scores), and (3) remediated reading and spelling impairments (normal reading and spelling scores); and a control group of (4) typically developing children. All groups were matched for age, gender, handedness, and IQ. We hypothesized that the dyslexia group would show cortical abnormalities in regions of the reading network relative to controls, irrespective of remediation status. Such a finding would support that cortical abnormalities are inherent to dyslexia and are not a consequence of abnormal reading experience. Results revealed increased CT of the left fusiform gyrus in the dyslexia group relative to controls. Similarly, the dyslexia group showed CT increase of the right superior temporal gyrus, extending into the planum temporale, which resulted in a rightward CT asymmetry on lateralization indices. There were no group differences in SA, GMV, or their lateralization. These findings held true regardless of remediation status. Each reading level group showed the same "double hit" of atypically increased left fusiform CT and rightward superior temporal CT asymmetry. Thus, findings provide evidence that a developmental history of dyslexia is associated with CT abnormalities, independent of remediation status.

Reading the dyslexic brain: multiple dysfunctional routes revealed by a new meta-analysis of PET and fMRI activation studies

Developmental dyslexia has been the focus of much functional anatomical research. The main trust of this work is that typical developmental dyslexics have a dysfunction of the phonological and orthography to phonology conversion systems, in which the left occipito-temporal cortex has a crucial role. It remains to be seen whether there is a systematic co-occurrence of dysfunctional patterns of different functional systems perhaps converging on the same brain regions associated with the reading deficit. Such evidence would be relevant for theories like, for example, the magnocellular/attentional or the motor/cerebellar ones, which postulate a more basic and anatomically distributed disorder in dyslexia. We addressed this issue with a meta-analysis of all the imaging literature published until September 2013 using a combination of hierarchical clustering and activation likelihood estimation methods. The clustering analysis on 2360 peaks identified 193 clusters, 92 of which proved spatially significant. Following binomial tests on the clusters, we found left hemispheric network specific for normal controls (i.e., of reduced involvement in dyslexics) including the left inferior frontal, premotor, supramarginal cortices and the left infero-temporal and fusiform regions: these were preferentially associated with reading and the visual-to-phonology processes. There was also a more dorsal left fronto-parietal network: these clusters included peaks from tasks involving phonological manipulation, but also motoric or visuo-spatial perception/attention. No cluster was identified in area V5 for no task, nor cerebellar clusters showed a reduced association with dyslexics. We conclude that the examined literature demonstrates a specific lack of activation of the left occipito-temporal cortex in dyslexia particularly for reading and reading-like behaviors and for visuo-phonological tasks. Additional deficits of motor and attentional systems relevant for reading may be associated with altered functionality of dorsal left fronto-parietal cortex.

Working-memory training improves developmental dyslexia in Chinese children

Although plasticity in the neural system underlies working memory, and working memory can be improved by training, there is thus far no evidence that children with developmental dyslexia can benefit from working-memory training. In the present study, thirty dyslexic children aged 8-11 years were recruited from an elementary school in Wuhan, China. They received working-memory training, including training in visuospatial memory, verbal memory, and central executive tasks. The difficulty of the tasks was adjusted based on the performance of each subject, and the training sessions lasted 40 minutes per day, for 5 weeks. The results showed that working-memory training significantly enhanced performance on the nontrained working memory tasks such as the visuospatial, the verbal domains, and central executive tasks in children with developmental dyslexia. More importantly, the visual rhyming task and reading fluency task were also significantly improved by training. Progress on working memory measures was related to changes in reading skills. These experimental findings indicate that working memory is a pivotal factor in reading development among children with developmental dyslexia, and interventions to improve working memory may help dyslexic children to become more proficient in reading.

What does the brain of children with developmental dyslexia tell us about reading improvement? ERP evidence from an intervention study

Intervention is key to managing developmental dyslexia (DD), but not all children with DD benefit from treatment. Some children improve (improvers, IMP), whereas others do not improve (non-improvers, NIMP). Neurobiological differences between IMP and NIMP have been suggested, but studies comparing IMP and NIMP in childhood are missing. The present study examined whether ERP patterns change with treatment and differ between IMP and NIMP. We investigated the ERPs of 28 children with DD and 25 control children (CON) while performing a phonological lexical decision (PLD) task before and after a 6-month intervention. After intervention children with DD were divided into IMP (n = 11) and NIMP (n = 17). In the PLD–task children were visually presented with words, pseudohomophones, pseudowords, and false fonts and had to decide whether the presented stimulus sounded like an existing German word or not. Prior to intervention IMP showed higher N300 amplitudes over fronto-temporal electrodes compared to NIMP and CON and N400 amplitudes were attenuated in both IMP and NIMP compared to CON. After intervention N300 amplitudes of IMP were comparable to those of CON and NIMP. This suggests that the N300, which has been related to phonological access of orthographic stimuli and integration of orthographic and phonological representations, might index a compensatory mechanism or precursor that facilitates reading improvement. The N400, which is thought to reflect grapheme-phoneme conversion or the access to the orthographic lexicon increased in IMP from pre to post and was comparable to CON after intervention. Correlations between N300 amplitudes pre, growth in reading ability and N400 amplitudes post indicated that higher N300 amplitudes might be important for reading improvement and increase in N400 amplitudes. The results suggest that children with DD, showing the same cognitive profile might differ regarding their neuronal profile which could further influence reading improvement.

Shared vs. specific brain activation changes in dyslexia after training of phonology, attention, or reading

Whereas the neurobiological basis of developmental dyslexia has received substantial attention, only little is known about the processes in the brain during remediation. This holds in particular in light of recent findings on cognitive subtypes of dyslexia which suggest interactions between individual profiles, training methods, and also the task in the scanner. Therefore, we trained three groups of German dyslexic primary school children in the domains of phonology, attention, or visual word recognition. We compared neurofunctional changes after 4 weeks of training in these groups to those in untrained normal readers in a reading task and in a task of visual attention. The overall reading improvement in the dyslexic children was comparable over groups. It was accompanied by substantial increase of the activation level in the visual word form area (VWFA) during a reading task inside the scanner. Moreover, there were activation increases that were unique for each training group in the reading task. In contrast, when children performed the visual attention task, shared training effects were found in the left inferior frontal sulcus and gyrus, which varied in amplitude between the groups. Overall, the data reveal that different remediation programmes matched to individual profiles of dyslexia may improve reading ability and commonly affect the VWFA in dyslexia as a shared part of otherwise distinct networks.

Brain activation during phonological and semantic processing of Chinese characters in deaf signers

Previous studies found altered brain function in deaf individuals reading alphabetic orthographies. However, it is not known whether similar alterations of brain function are characteristic of non-alphabetic writing systems and whether alterations are specific to certain kinds of lexical tasks. Here we examined differences in brain activation between Chinese congenitally deaf individuals (CD) and hearing controls (HC) during character reading tasks requiring phonological and semantic judgments. For both tasks, we found that CD showed less activation than HC in left inferior frontal gyrus, but greater activation in several right hemisphere regions including inferior frontal gyrus, angular gyrus, and inferior temporal gyrus. Although many group differences were similar across tasks, greater activation in right middle frontal gyrus was more pronounced for the rhyming compared to the meaning task. Finally, within the deaf individuals better performance on the rhyming task was associated with less activation in right inferior parietal lobule and angular gyrus. Our results in Chinese CD are broadly consistent with previous studies in alphabetic languages suggesting greater engagement of inferior frontal gyrus and inferior parietal cortex for reading that is largely independent of task, with the exception of right middle frontal gyrus for phonological processing. The brain behavior correlations potentially indicate that CD that more efficiently use the right hemisphere are better readers.

Temporal sampling in vision and the implications for dyslexia

It has recently been suggested that dyslexia may manifest as a deficit in the neural synchrony underlying language-based codes (Goswami, 2011), such that the phonological deficits apparent in dyslexia occur as a consequence of poor synchronisation of oscillatory brain signals to the sounds of language. There is compelling evidence to support this suggestion, and it provides an intriguing new development in understanding the aetiology of dyslexia. It is undeniable that dyslexia is associated with poor phonological coding, however, reading is also a visual task, and dyslexia has also been associated with poor visual coding, particularly visuo-spatial sensitivity. It has been hypothesized for some time that specific frequency oscillations underlie visual perception. Although little research has been done looking specifically at dyslexia and cortical frequency oscillations, it is possible to draw on converging evidence from visual tasks to speculate that similar deficits could occur in temporal frequency oscillations in the visual domain in dyslexia. Thus, here the plausibility of a visual correlate of the Temporal Sampling Framework is considered, leading to specific hypotheses and predictions for future research. A common underlying neural mechanism in dyslexia, may subsume qualitatively different manifestations of reading difficulty, which is consistent with the heterogeneity of the disorder, and may open the door for a new generation of exciting research.

Brain mechanisms and reading remediation: more questions than answers

Dyslexia is generally diagnosed in childhood and is characterised by poor literacy skills with associated phonological and perceptual problems. Compensated dyslexic readers are adult readers who have a documented history of childhood dyslexia but as adults can read and comprehend written text well. Uncompensated dyslexic readers are adults who similarly have a documented history of reading impairment but remain functionally reading-impaired all their lives. There is little understanding of the neurophysiological basis for how or why some children become compensated, while others do not, and there is little knowledge about neurophysiological changes that occur with remedial programs for reading disability. This paper will review research looking at reading remediation, particularly in the context of the underlying neurophysiology.

Neuroimaging of reading intervention: a systematic review and activation likelihood estimate meta-analysis

A growing number of studies examine instructional training and brain activity. The purpose of this paper is to review the literature regarding neuroimaging of reading intervention, with a particular focus on reading difficulties (RD). To locate relevant studies, searches of peer-reviewed literature were conducted using electronic databases to search for studies from the imaging modalities of fMRI and MEG (including MSI) that explored reading intervention. Of the 96 identified studies, 22 met the inclusion criteria for descriptive analysis. A subset of these (8 fMRI experiments with post-intervention data) was subjected to activation likelihood estimate (ALE) meta-analysis to investigate differences in functional activation following reading intervention. Findings from the literature review suggest differences in functional activation of numerous brain regions associated with reading intervention, including bilateral inferior frontal, superior temporal, middle temporal, middle frontal, superior frontal, and postcentral gyri, as well as bilateral occipital cortex, inferior parietal lobules, thalami, and insulae. Findings from the meta-analysis indicate change in functional activation following reading intervention in the left thalamus, right insula/inferior frontal, left inferior frontal, right posterior cingulate, and left middle occipital gyri. Though these findings should be interpreted with caution due to the small number of studies and the disparate methodologies used, this paper is an effort to synthesize across studies and to guide future exploration of neuroimaging and reading intervention.

Neonatal hypoxia, hippocampal atrophy, and memory impairment: evidence of a causal sequence

Neonates treated for acute respiratory failure experience episodes of hypoxia. The hippocampus, a structure essential for memory, is particularly vulnerable to such insults. Hence, some neonates undergoing treatment for acute respiratory failure might sustain bilateral hippocampal pathology early in life and memory problems later in childhood. We investigated this possibility in a cohort of 40 children who had been treated neonatally for acute respiratory failure but were free of overt neurological impairment. The cohort had mean hippocampal volumes (HVs) significantly below normal control values, memory scores significantly below the standard population means, and memory quotients significantly below those predicted by their full scale IQs. Brain white matter volume also fell below the volume of the controls, but brain gray matter volumes and scores on nonmnemonic neuropsychological tests were within the normal range. Stepwise linear regression models revealed that the cohort's HVs were predictive of degree of memory impairment, and gestational age at treatment was predictive of HVs: the younger the age, the greater the atrophy. We conclude that many neonates treated for acute respiratory failure sustain significant hippocampal atrophy as a result of the associated hypoxia and, consequently, show deficient memory later in life.

Cerebellar function in developmental dyslexia

Developmental dyslexia is a genetically based neurobiological syndrome, which is characterized by reading difficulty despite normal or high general intelligence. Even remediated dyslexic readers rarely achieve fast, fluent reading. Some dyslexics also have impairments in attention, short-term memory, sequencing (letters, word sounds, and motor acts), eye movements, poor balance, and general clumsiness. The presence of "cerebellar" motor and fluency symptoms led to the proposal that cerebellar dysfunction contributes to the etiology of dyslexia. Supporting this, functional imaging studies suggest that the cerebellum is part of the neural network supporting reading in typically developing readers, and reading difficulties have been reported in patients with cerebellar damage. Differences in both cerebellar asymmetry and gray matter volume are some of the most consistent structural brain findings in dyslexics compared with good readers. Furthermore, cerebellar functional activation patterns during reading and motor learning can differ in dyslexic readers. Behaviorally, some children and adults with dyslexia show poorer performance on cerebellar motor tasks, including eye movement control, postural stability, and implicit motor learning. However, many dyslexics do not have cerebellar signs, many cerebellar patients do not have reading problems, and differences in dyslexic brains are found throughout the whole reading network, and not isolated to the cerebellum. Therefore, impaired cerebellar function is probably not the primary cause of dyslexia, but rather a more fundamental neurodevelopmental abnormality leads to differences throughout the reading network.

Consequences of severe visual-spatial deficits for reading acquisition: evidence from Williams syndrome

To further understand the nature of the visual-spatial representations required for successful acquisition of written language skills, we investigated the written language abilities of two individuals with Williams syndrome (WS) a developmental genetic disorder in which the presence of severe visual-spatial developmental delays and deficits has been well established. Using a case study approach, we examined the relationship between reading achievement and general cognitive ability, phonological skills, and visual-spatial skills for the two individuals. We found that, despite the strong similarity between the two individuals in terms of their verbal and non-verbal cognitive abilities and their phonological abilities (as well as chronological age and educational opportunities), their reading and spelling abilities differed by more than 5 grade levels. We present evidence that the difference in written language performance was likely to be due to differences in the severity and nature of their visual-spatial impairment. Moreover, we show that specific difficulty processing the orientation of visual stimuli is related to the reading difficulties of one of the two individuals. These results underscore the contribution of visual-spatial abilities to the reading acquisition process and identify WS as a potential source of valuable information regarding the role of visual-spatial processing in reading development.

Writing affects the brain network of reading in Chinese: a functional magnetic resonance imaging study

We examined the hypothesis that learning to write Chinese characters influences the brain's reading network for characters. Students from a college Chinese class learned 30 characters in a character-writing condition and 30 characters in a pinyin-writing condition. After learning, functional magnetic resonance imaging collected during passive viewing showed different networks for reading Chinese characters and English words, suggesting accommodation to the demands of the new writing system through short-term learning. Beyond these expected differences, we found specific effects of character writing in greater activation (relative to pinyin writing) in bilateral superior parietal lobules and bilateral lingual gyri in both a lexical decision and an implicit writing task. These findings suggest that character writing establishes a higher quality representation of the visual-spatial structure of the character and its orthography. We found a greater involvement of bilateral sensori-motor cortex (SMC) for character-writing trained characters than pinyin-writing trained characters in the lexical decision task, suggesting that learning by doing invokes greater interaction with sensori-motor information during character recognition. Furthermore, we found a correlation of recognition accuracy with activation in right superior parietal lobule, right lingual gyrus, and left SMC, suggesting that these areas support the facilitative effect character writing has on reading. Finally, consistent with previous behavioral studies, we found character-writing training facilitates connections with semantics by producing greater activation in bilateral middle temporal gyri, whereas pinyin-writing training facilitates connections with phonology by producing greater activation in right inferior frontal gyrus.

Abnormal visual motion processing is not a cause of dyslexia

Developmental dyslexia is a reading disorder, yet deficits also manifest in the magnocellular-dominated dorsal visual system. Uncertainty about whether visual deficits are causal or consequential to reading disability encumbers accurate identification and appropriate treatment of this common learning disability. Using fMRI, we demonstrate in typical readers a relationship between reading ability and activity in area V5/MT during visual motion processing and, as expected, also found lower V5/MT activity for dyslexic children compared to age-matched controls. However, when dyslexics were matched to younger controls on reading ability, no differences emerged, suggesting that weakness in V5/MT may not be causal to dyslexia. To further test for causality, dyslexics underwent a phonological-based reading intervention. Surprisingly, V5/MT activity increased along with intervention-driven reading gains, demonstrating that activity here is mobilized through reading. Our results provide strong evidence that visual magnocellular dysfunction is not causal to dyslexia but may instead be consequential to impoverished reading.

VIDEO ABSTRACT

Enhanced recognition memory after incidental encoding in children with developmental dyslexia

Developmental dyslexia (DD) has previously been associated with a number of cognitive deficits. Little attention has been directed to cognitive functions that remain intact in the disorder, though the investigation and identification of such strengths might be useful for developing new, and improving current, therapeutical interventions. In this study, an old/new recognition memory paradigm was used to examine previously untested aspects of declarative memory in children with DD and typically developing control children. The DD group was not only not impaired at the task, but actually showed superior recognition memory, as compared to the control children. These findings complement previous reports of enhanced cognition in other domains (e.g., visuo-spatial processing) in DD. Possible underlying mechanisms for the observed DD advantage in declarative memory, and the possibility of compensation by this system for reading deficits in dyslexia, are discussed.

Sex-specific gray matter volume differences in females with developmental dyslexia

Developmental dyslexia, characterized by unexpected reading difficulty, is associated with anomalous brain anatomy and function. Previous structural neuroimaging studies have converged in reports of less gray matter volume (GMV) in dyslexics within left hemisphere regions known to subserve language. Due to the higher prevalence of dyslexia in males, these studies are heavily weighted towards males, raising the question whether studies of dyslexia in females only and using the same techniques, would generate the same findings. In a replication study of men, we obtained the same findings of less GMV in dyslexics in left middle/inferior temporal gyri and right postcentral/supramarginal gyri as reported in the literature. However, comparisons in women with and without dyslexia did not yield left hemisphere differences, and instead, we found less GMV in right precuneus and paracentral lobule/medial frontal gyrus. In boys, we found less GMV in left inferior parietal cortex (supramarginal/angular gyri), again consistent with previous work, while in girls differences were within right central sulcus, spanning adjacent gyri, and left primary visual cortex. Our investigation into anatomical variants in dyslexia replicates existing studies in males, but at the same time shows that dyslexia in females is not characterized by involvement of left hemisphere language regions but rather early sensory and motor cortices (i.e., motor and premotor cortex, primary visual cortex). Our findings suggest that models on the brain basis of dyslexia, primarily developed through the study of males, may not be appropriate for females and suggest a need for more sex-specific investigations into dyslexia.

Cortical signatures of dyslexia and remediation: an intrinsic functional connectivity approach

This observational, cross-sectional study investigates cortical signatures of developmental dyslexia, particularly from the perspective of behavioral remediation. We employed resting-state fMRI, and compared intrinsic functional connectivity (iFC) patterns of known reading regions (seeds) among three dyslexia groups characterized by (a) no remediation (current reading and spelling deficits), (b) partial remediation (only reading deficit remediated), and (c) full remediation (both reading and spelling deficits remediated), and a group of age- and IQ-matched typically developing children (TDC) (total N = 44, age range = 7-15 years). We observed significant group differences in iFC of two seeds located in the left posterior reading network - left intraparietal sulcus (L.IPS) and left fusiform gyrus (L.FFG). Specifically, iFC between L.IPS and left middle frontal gyrus was significantly weaker in all dyslexia groups, irrespective of remediation status/literacy competence, suggesting that persistent dysfunction in the fronto-parietal attention network characterizes dyslexia. Additionally, relative to both TDC and the no remediation group, the remediation groups exhibited stronger iFC between L.FFG and right middle occipital gyrus (R.MOG). The full remediation group also exhibited stronger negative iFC between the same L.FFG seed and right medial prefrontal cortex (R.MPFC), a core region of the default network These results suggest that behavioral remediation may be associated with compensatory changes anchored in L.FFG, which reflect atypically stronger coupling between posterior visual regions (L.FFG-R.MOG) and greater functional segregation between task-positive and task-negative regions (L.FFG-R.MPFC). These findings were bolstered by significant relationships between the strength of the identified functional connections and literacy scores. We conclude that examining iFC can reveal cortical signatures of dyslexia with particular promise for monitoring neural changes associated with behavioral remediation.

Optimal outcome in individuals with a history of autism

BACKGROUND

Although autism spectrum disorders (ASDs) are generally considered lifelong disabilities, literature suggests that a minority of individuals with an ASD will lose the diagnosis. However, the existence of this phenomenon, as well as its frequency and interpretation, is still controversial: were they misdiagnosed initially, is this a rare event, did they lose the full diagnosis, but still suffer significant social and communication impairments or did they lose all symptoms of ASD and function socially within the normal range?

METHODS

The present study documents a group of these optimal outcome individuals (OO group, n=34) by comparing their functioning on standardized measures to age, sex, and nonverbal IQ matched individuals with high-functioning autism (HFA group, n=44) or typical development (TD group, n=34). For this study, 'optimal outcome' requires losing all symptoms of ASD in addition to the diagnosis, and functioning within the nonautistic range of social interaction and communication. Domains explored include language, face recognition, socialization, communication, and autism symptoms.

RESULTS

Optimal outcome and TD groups' mean scores did not differ on socialization, communication, face recognition, or most language subscales, although three OO individuals showed below-average scores on face recognition. Early in their development, the OO group displayed milder symptoms than the HFA group in the social domain, but had equally severe difficulties with communication and repetitive behaviors.

CONCLUSIONS

Although possible deficits in more subtle aspects of social interaction or cognition are not ruled out, the results substantiate the possibility of OO from autism spectrum disorders and demonstrate an overall level of functioning within normal limits for this group.

Dyslexia

Developmental dyslexia (DD) is a specific and persistent disability affecting the acquisition of written language. Prevalence is estimated to be between 5% and 17% of school-aged children; it therefore represents a major public health issue. Neurological in origin, its causes are unknown, although there is a clear genetic component. Diagnosis rests upon the use of standardized tests and tools to assess reading and spelling, as well as phonological skills. The importance of early diagnosis cannot be overemphasized and much current research is focusing on screening and prediction, particularly through use of objective imaging techniques (e.g., EEG/MEG), which have implicated cortical abnormalities in central auditory processing (Giraud et al., 2005, 2008). Remediation should be intensive, begin as early as possible, and be tailored to the individual. Phonics based treatments are most effective and several variants, incorporating temporal auditory, articulatory, or multisensory training exercises, have been developed or proposed. Clinical improvements in phonological skills and reading with such treatments have been shown to correlate with changes in the brains of dyslexic children in several functional imaging studies.

Grey matter alterations co-localize with functional abnormalities in developmental dyslexia: an ALE meta-analysis

The neural correlates of developmental dyslexia have been investigated intensively over the last two decades and reliable evidence for a dysfunction of left-hemispheric reading systems in dyslexic readers has been found in functional neuroimaging studies. In addition, structural imaging studies using voxel-based morphometry (VBM) demonstrated grey matter reductions in dyslexics in several brain regions. To objectively assess the consistency of these findings, we performed activation likelihood estimation (ALE) meta-analysis on nine published VBM studies reporting 62 foci of grey matter reduction in dyslexic readers. We found six significant clusters of convergence in bilateral temporo-parietal and left occipito-temporal cortical regions and in the cerebellum bilaterally. To identify possible overlaps between structural and functional deviations in dyslexic readers, we conducted additional ALE meta-analyses of imaging studies reporting functional underactivations (125 foci from 24 studies) or overactivations (95 foci from 11 studies ) in dyslexics. Subsequent conjunction analyses revealed overlaps between the results of the VBM meta-analysis and the meta-analysis of functional underactivations in the fusiform and supramarginal gyri of the left hemisphere. An overlap between VBM results and the meta-analysis of functional overactivations was found in the left cerebellum. The results of our study provide evidence for consistent grey matter variations bilaterally in the dyslexic brain and substantial overlap of these structural variations with functional abnormalities in left hemispheric regions.

Differences in integrity of white matter and changes with training in spelling impaired children: a diffusion tensor imaging study

While the functional correlates of spelling impairment have been rarely investigated, to our knowledge no study exists regarding the structural characteristics of spelling impairment and potential changes with interventions. Using diffusion tensor imaging at 3.0 T, we here therefore sought to investigate (a) differences between children with poor spelling abilities (training group and waiting group) and controls, and (b) the effects of a morpheme-based spelling intervention in children with poor spelling abilities on DTI parameters. A baseline comparison of white matter indices revealed significant differences between controls and spelling-impaired children, mainly located in the right hemisphere (superior corona radiata (SCR), posterior limb of internal capsule, superior longitudinal fasciculus). After 5 weeks of training, spelling ability improved in the training group, along with increases in fractional anisotropy and decreases of radial diffusivity in the right hemisphere compared to controls. In addition, significantly higher decreases of mean diffusivity in the right SCR for the spelling-impaired training group compared to the waiting group were observed. Our results suggest that spelling impairment is associated with differences in white-matter integrity in the right hemisphere. We also provide first indications that white matter changes occur during successful training, but this needs to be more specifically addressed in future research.

Differences in brain function and changes with intervention in children with poor spelling and reading abilities

Previous fMRI studies in English-speaking samples suggested that specific interventions may alter brain function in language-relevant networks in children with reading and spelling difficulties, but this research strongly focused on reading impaired individuals. Only few studies so far investigated characteristics of brain activation associated with poor spelling ability and whether a specific spelling intervention may also be associated with distinct changes in brain activity patterns. We here investigated such effects of a morpheme-based spelling intervention on brain function in 20 children with comparatively poor spelling and reading abilities using repeated fMRI. Relative to 10 matched controls, children with comparatively poor spelling and reading abilities showed increased activation in frontal medial and right hemispheric regions and decreased activation in left occipito-temporal regions prior to the intervention, during processing of a lexical decision task. After five weeks of intervention, spelling and reading comprehension significantly improved in the training group, along with increased activation in the left temporal, parahippocampal and hippocampal regions. Conversely, the waiting group showed increases in right posterior regions. Our findings could indicate an increased left temporal activation associated with the recollection of the new learnt morpheme-based strategy related to successful training.

Three requirements for justifying an educational neuroscience

BACKGROUND

Over the past quarter century, efforts to bridge between research in the neurosciences and research, theory, and practice in education have grown from a mere hope to noteworthy scholarly sophistication. Many dedicated educational researchers have developed the secondary expertise in the necessary neurosciences and related fields to generate both empirical research and theoretical syntheses of noteworthy promise. Nonetheless, thoughtful and critical scholars in education have expressed concern about both the intellectual coherence and ethical dangers of this new area. It is still an open question whether educational neuroscience is for some time yet to remain only a formative study area for adventurous scholars or is already a fully fledged field of educational scholarship.

AIMS

In this paper, I suggest that to be a worthy field of educational research, educational neuroscience will need to address three issues: intellectual coherence, mutually informing and respected scholarly expertise, and an ethical commitment to the moral implications and obligations shared within educational research generally. I shall set forth some examples of lapses in this regard, focusing primarily on work on reading development, as that is my area of expertise, and make recommendations for due diligence. Arguments. First, intellectual coherence requires both precision in definition of technical terms (so that diverse scholars and professionals may communicate findings and insights consistently across fields), and precision in the logical warrants by which educational implications are drawn from empirical data from the neurosciences. Both needs are facilitated by careful attention to categorical boundary and avoidance of category error. Second, educational neuroscientists require focused and broad expertise in both the neurosciences and educational scholarship on teaching and learning in classrooms (and/or ancillary fields). If history is our guide, neuroscience implications for practice will prove unlikely in practice without expertise on practice. Additionally, respect for the expertise of others in this hybrid and necessarily collaborative enterprise is required. Third, educational neuroscience must take seriously the heightened moral and ethical concerns and commitments of educational professionals generally and educational researchers particularly. This means keeping a vigilant eye towards preserving the integrity of empirical and theoretical findings against rhetorical misuse by educational marketers, policy makers, and polemicists targeting the general public.

CONCLUSIONS

I conclude that educational neuroscience is more than a hybrid patchwork of individual interests constituting a study area, and is perhaps ready to stand as a legitimate field of educational inquiry. It will not be accepted as such, however, nor should it be, unless the need to demonstrate a capacity for consistent intellectual coherence, scholarly expertise, and ethical commitment is met.