Impaired letter-string processing in developmental dyslexia: what visual-to-phonology code mapping disorder?

Visual attention span deficit in developmental dyslexia: A meta-analysis

BACKGROUND

Visual attention span (VAS) refers to the number of visual elements processed simultaneously in a multielement array. Yet, there are mixed findings regarding VAS deficit in developmental dyslexia (DD) across different tasks, stimuli, languages, control groups, and ages.

AIM

The present meta-analysis aimed to investigate VAS deficit in DD and factors moderating VAS deficit in DD.

METHODS

A meta-analysis based on 32 articles, 54 independent studies, and 4211 subjects was conducted. Effect sizes for each study were calculated and a random-effect model was selected. Task and stimulus types in the VAS task, writing system, orthographic depth, control group type, and age were included as possible moderators.

RESULTS

1) VAS in dyslexic individuals was significantly worse than typically developing individuals; 2) Task-stimulus type (report-verbal/n-back-verbal/n-back-nonverbal), writing system (alphabetic vs. Chinese), and control group type (age matched vs. reading matched) significantly moderated VAS deficit in DD. VAS deficit was more severe in report task with verbal stimuli than in n-back task with verbal and nonverbal stimuli. VAS deficit was more severe in alphabetic language than in Chinese. VAS deficit was more severe when compared with age-matched controls than compared with reading-matched controls.

CONCLUSION

VAS deficit is a possible etiology for DD and moderated by task-stimulus type, writing system, and control group type. These findings have important implications for the understanding of DD.

Toward the characterization of a visual form of developmental dyslexia: Reduced visuo-attentional capacity for processing multiple stimuli made of separable features

Some dyslexics cannot process multiple letters simultaneously. It has been argued that this reduced visuo-attentional (VA) letter span could result from poor reading ability and experience. Here, moving away from reading context, we showed that dyslexic group exhibited slower visual search than normal readers group for "symbols", defined as graphic stimuli made up of separable visual features, but not for filled objects. Slowness in symbol visual search was explained by reduced VA field and atypical ocular behaviour when processing those letter-like stimuli and was associated with reduced VA letter span and impaired elementary visuo-spatial perception. Such a basic visual search deficit can hardly be attributed to poor reading ability and experience. Moreover, because it is specific to letter-like stimuli (i.e., "symbols"), it can specifically hinder reading acquisition. Symbol visual search can easily be tested in the pre-reading phase, opening up prospects for early risk detection and prevention of VA dyslexia.

Visual attention span capacity in developmental dyslexia: A meta-analysis

The visual attention span (VAS) deficit theory of developmental dyslexia (DD) indicates that impaired VAS may cause reading disabilities. However, whether people with dyslexia have VAS deficit is still controversial. The current review evaluates the literature regarding the relationship between VAS and poor reading, as it also examines the possible moderators in measuring the VAS capacity of individuals with dyslexia. A total of 25 papers, with participants of 859 readers with dyslexia and 1048 typically developing readers were included in the meta-analysis. The sample sizes, means and standard deviations (SDs) of the scores in VAS tasks were extracted separately from the two groups, which were used to calculate the effect sizes of group differences in SDs and means by the robust variance estimation model. Results showed higher SDs and lower averages of the VAS test scores for readers with dyslexia than those for typically developing readers, revealing high individual variability and remarkable deficits in VAS of DD. Further subgroup analyses showed that the characteristics of VAS tasks, background languages, and participants modulated the group differences in VAS capacities. Particularly, the partial report task with symbols of relatively high visual complexity and key pressing may be the optimal measurement of VAS skills. A greater VAS deficit in DD was observed in more opaque languages, with a trend of developmental increase in attention deficit, especially at the primary school level. Moreover, this VAS deficit seemed to be independent of the phonological deficit of dyslexia. These findings to some extent supported the VAS deficit theory of DD and (partially) explained the controversial relationship between VAS impairment and reading disabilities.

The visual-attention span deficit in developmental dyslexia: Review of evidence for a visual-attention-based deficit

The visual attention span (VAS) deficit hypothesis in developmental dyslexia posits that a subset of dyslexic individuals shows a multielement parallel processing deficit due to reduced visual attention capacity. However, the attention-based interpretation of poor performance on VAS tasks is hotly debated. The purpose of the present paper is to clarify this issue through a critical review of relevant behavioural and neurobiological findings. We first examine the plausibility of alternative verbal interpretations of VAS performance, evaluating whether performance on VAS tasks might reflect verbal short-term memory, verbal coding or visual-to-verbal mapping skills. We then focus on the visual dimensions of VAS tasks to question whether VAS primarily reflects visuo-attentional rather than more basic visual skills. Scrutiny of the available behavioural and neurobiological findings not only points to a deficit of visual attention in dyslexic individuals with impaired VAS but further suggests a selective endogenous attentional system deficit that relates to atypical functioning of the brain dorsal attentional network. The overview clarifies the debate on what is being measured through VAS tasks and provides insights on how to interpret the VAS deficit in developmental dyslexia.

Visuo-spatial attention deficit in children with reading difficulties

Although developmental reading disorders (developmental dyslexia) have been mainly associated with auditory-phonological deficits, recent longitudinal and training studies have shown a possible causal role of visuo-attentional skills in reading acquisition. Indeed, visuo-attentional mechanisms could be involved in the orthographic processing of the letter string and the graphemic parsing that precede the grapheme-to-phoneme mapping. Here, we used a simple paper-and-pencil task composed of three labyrinths to measure visuo-spatial attention in a large sample of primary school children (n = 398). In comparison to visual search tasks requiring visual working memory, our labyrinth task mainly measures distributed and focused visuo-spatial attention, also controlling for sensorimotor learning. Compared to typical readers (n = 340), children with reading difficulties (n = 58) showed clear visuo-spatial attention impairments that appear not linked to motor coordination and procedural learning skills implicated in this paper and pencil task. Since visual attention is dysfunctional in about 40% of the children with reading difficulties, an efficient reading remediation program should integrate both auditory-phonological and visuo-attentional interventions.

Attentional limits in visual search with and without dorsal parietal dysfunction: space-based window or object-based span?

Attentional resource and distribution are specifically impaired in simultanagnosia, and also in the visuo-attentional form of developmental dyslexia. Both clinical conditions are conceived as a limitation of simultaneous visual processing after superior parietal lobule (SPL) dysfunction (review in Valdois et al., 2019). However, a reduced space-based attentional window (i.e. a limited visual eccentricity at which the target object can be identified, Khan et al. 2016) has been demonstrated in simultanagnosia versus a reduced object-based span (i.e. a limited number of objects processed at each fixation, Bosse et al., 2007) in developmental dyslexia. In healthy individuals, the cost in reaction times per item in serial search tasks suggests that a group of objects is processed simultaneously at a time, but this group is also undefined and depends on the visual complexity of the task. Healthy individuals and a patient with simultanagnosia performed serial search tasks involving either symbols (made of separable features) or objects made of non-separable features, and with distractors that were either all identical or all dissimilar. We used a moving window paradigm to determine whether the task was performed with a "working space" versus a "working span" limitation in control group and in patient with bilateral SPL damage. We found that healthy individuals performed search in a color task comprising non-separable feature objects and dissimilar distractors with a limited space-based attentional window; this attentional window, as well as the mean saccade amplitude used to displace it across the visual display, were independent of set size, thus inconsistent with an object-based attentional span. In the symbol task comprising a feature-absent search in which all feature-present distractors were dissimilar, we observed that mean saccade amplitude decreased with set size and that search performance could not be mimicked by a moving window of a single diameter; instead participants seemed to process a fixed number of symbols at a time (object-based span). Following bilateral SPL lesions, patient IG demonstrated a similar space-based search process in the color search task with a normal attentional window. In contrast, her cost-per-item in the symbol task increased dramatically, demonstrating a clear deficit of simultaneous object perception. These results confirmed the specific contribution of the SPL to the visual processing of multiple objects made of separable features (like letters), and more dramatically when they are all different, which explains the specific difficulty for a reading beginner in case of SPL dysfunction.

Poor reading is characterized by a more connected network with wrong hubs

Using graph theory, we examined topological organization of the language network in Chinese children with poor reading during an auditory rhyming task and a visual spelling task, compared to reading-matched controls and age-matched controls. First, poor readers (PR) showed reduced clustering coefficient in the left inferior frontal gyrus (IFG) and higher nodal efficiency in the bilateral superior temporal gyri (STG) during the visual task, indicating a less functionally specialized cluster around the left IFG and stronger functional links between bilateral STGs and other regions. Furthermore, PR adopted additional right-hemispheric hubs in both tasks, which may explain increased global efficiency across both tasks and lower normalized characteristic shortest path length in the visual task for the PR. These results underscore deficits in the left IFG during visual word processing and conform previous findings about compensation in the right hemisphere in children with poor reading.

Visual attention span and phonological skills in Chinese developmental dyslexia

BACKGROUND

It has been debated whether visual attention span deficit was independent from phonological deficit in alphabetic developmental dyslexia. Yet, this issue has never been examined in Chinese developmental dyslexia.

AIM

The aim of the present study was to concurrently investigate visual attention span deficit and phonological deficit in Chinese developmental dyslexia, and examine the relationship between them.

METHODS

A total of 45 Chinese dyslexic and 43 control children aged between 8 and 11 years old participated in this study. A visual one-back paradigm with both verbal stimuli (character and digit strings) and nonverbal stimuli (color dots and symbols) was employed for measuring visual attention span. Phonological skills were measured by three dimensions: phonological awareness, rapid automatized naming, and verbal short-term memory.

RESULTS

Chinese dyslexic children showed deficits in verbal visual attention span and all three dimensions of phonological skills, but not in nonverbal visual attention span. Phonological skills significantly contributed to explaining variance of reading skills and classifying dyslexic and control memberships. Almost all Chinese dyslexic participants who showed a deficit in visual attention span also showed a phonological deficit.

CONCLUSION

The study suggests that visual attention span deficit is not independent from phonological deficit in Chinese developmental dyslexia.

Bálint syndrome

This chapter starts by reviewing the various interpretations of Bálint syndrome over time. We then develop a novel integrative view in which we propose that the various symptoms, historically reported and labeled by various authors, result from a core mislocalization deficit. This idea is in accordance with our previous proposal that the core deficit of Bálint syndrome is attentional (Pisella et al., 2009, 2013, 2017) since covert attention improves spatial resolution in visual periphery (Yeshurun and Carrasco, 1998); a deficit of covert attention would thus increase spatial uncertainty and thereby impair both visual object identification and visuomotor accuracy. In peripheral vision, we perceive the intrinsic characteristics of the perceptual elements surrounding us, but not their precise localization (Rosenholtz et al., 2012a,b), such that without covert attention we cannot organize them to their respective and recognizable objects; this explains why perceptual symptoms (simultanagnosia, neglect) could result from visual mislocalization. The visuomotor symptoms (optic ataxia) can be accounted for by both visual and proprioceptive mislocalizations in an oculocentric reference frame, leading to field and hand effects, respectively. This new pathophysiological account is presented along with a model of posterior parietal cortex organization in which the superior part is devoted to covert attention, while the right inferior part is involved in visual remapping. When the right inferior parietal cortex is damaged, additional representational mislocalizations across saccades worsen the clinical picture of peripheral mislocalizations due to an impairment of covert attention.

The relation of visual attention span with serial and discrete rapid automatized naming and reading

Visual attention span (VAS) has been shown to make a unique contribution to reading skills over and above phonological awareness and rapid automatized naming (RAN). In the current study, we examined the nature of this unique relationship. In particular, we tested whether VAS reflects the retrieval of a verbal code, serial processing, or parallel multi-element processing. To this end, we presented 180 third graders with tasks for VAS, discrete RAN, and serial RAN as well as serial and discrete reading of short words, pseudowords, and long words. VAS was found to correlate with serial RAN but not with discrete RAN. More important, similar relations were found for VAS with serial and discrete reading, which clearly differed from the format-specific relations between RAN and reading. Together, these findings suggest that VAS and serial RAN are related but are associated with reading for different reasons. Serial RAN appears to reflect serial interword reading processes, whereas the unique contribution of VAS mainly involves the parallel processing of orthographic units within words.

Memory Deficits in Children with Developmental Dyslexia: A Reading-Level and Chronological-Age Matched Design

Developmental Dyslexia (DD) is considered a multifactorial deficit. Among the neurocognitive impairments identified in DD, it has been found that memory plays a particularly important role in reading and learning. The present study aims to investigate whether short-term memory (STM) and long-term memory (LTM) deficits could be related to poor reading experience or could be causal factors in DD. To verify that memory deficits in DD did not simply reflect differences in reading experience, 16 children with DD were not only compared to 16 chronological age-matched children (CA) but also to 16 reading level-matched children (RL) in verbal, visual-object, and visual-spatial STM and LTM tasks. Children with DD performed as well as RL, but worse than CA in all STM tasks. Considering LTM, the three groups did not differ in Visual-Object and Visual-Spatial Learning tasks. In the Verbal LTM task, DD recalled significantly fewer words than CA but not RL, while CA and RL showed a similar performance. The present results suggest that when reading experience was equated, children with DD and typical readers did not differ in STM and LTM, especially in the verbal modality, weakening claims that memory has a causal effect in reading impairments.

A universal reading network and its modulation by writing system and reading ability in French and Chinese children

Are the brain mechanisms of reading acquisition similar across writing systems? And do similar brain anomalies underlie reading difficulties in alphabetic and ideographic reading systems? In a cross-cultural paradigm, we measured the fMRI responses to words, faces, and houses in 96 Chinese and French 10-year-old children, half of whom were struggling with reading. We observed a reading circuit which was strikingly similar across languages and consisting of the left fusiform gyrus, superior temporal gyrus/sulcus, precentral and middle frontal gyri. Activations in some of these areas were modulated either by language or by reading ability, but without interaction between those factors. In various regions previously associated with dyslexia, reading difficulty affected activation similarly in Chinese and French readers, including the middle frontal gyrus, a region previously described as specifically altered in Chinese. Our analyses reveal a large degree of cross-cultural invariance in the neural correlates of reading acquisition and reading impairment.

Improving sentence reading performance in Chinese children with developmental dyslexia by training based on visual attention span

Deficits in the visual attention span (VAS) are thought to hamper reading performance in dyslexic individuals. However, the causal relationship between VAS deficits and reading disability remains unclear. The present study attempts to address this issue by using a VAS-based intervention to explore the possible influence of VAS on reading processes in Chinese children with dyslexia. Given the influence of the heterogeneity of dyslexia on intervention effects, VAS-impaired dyslexic and VAS-intact dyslexic individuals were separately trained. Therefore, there were five groups of participants in this study, including 10 trained dyslexic individuals with VAS deficits and 10 untrained dyslexic individuals with VAS dysfunction as the baseline reference, 10 trained and 10 untrained dyslexic individuals with an intact VAS, and fourteen age-matched normal readers for reference of normal level. All participants completed reading measures and a visual 1-back task, reflecting VAS capacity with non-verbal stimuli and non-verbal responses, before and after VAS-based training. VAS-based training tasks included a length estimation task regarding the bottom-up attention, visual search and digit cancelling tasks targeting top-down attentional modulation, and visual tracking tasks to train eye-movement control. The results showed that visual training only helped improve VAS skills in VAS-impaired dyslexic individuals receiving training. Meanwhile, their silent sentence reading accuracy improved after training, and there was a significant relationship between training improvements in VAS function and reading performance. The current findings suggest that VAS-based training has a far-transfer effect on linguistic level (i.e., fluent reading). These findings suggest the possibility that VAS-related training may help children with dyslexia improve their reading skills.

What bilateral damage of the superior parietal lobes tells us about visual attention disorders in developmental dyslexia

Neuroimaging studies have identified the superior parietal lobules bilaterally as the neural substrates of reduced visual attention (VA) span in developmental dyslexia. It remains however unclear whether the VA span deficit and the deficits in temporal and spatial attention shifting also reported in dyslexic children reflect a unitary spatio-temporal deficit of attention - probably linked to general posterior parietal dysfunction- or the dysfunction of distinct attentional systems that relate to different neural substrates. We explored this issue by testing an adult patient, IG, with a specific damage of the bilateral superior parietal lobules after stroke, on tasks assessing the VA span as well as temporal and spatial attention shifting. IG demonstrated a very severe VA span deficit, but preserved temporal attention shifting. Exogenous spatial orientation shifting was spared but her performance was impaired in endogenous attention. The overall findings show that distinct sub-systems of visual attention can be dissociated within the parietal lobe, suggesting that different attentional systems associated with specific neural networks can be selectively impaired in developmental dyslexia.

Meta-analytic findings reveal lower means but higher variances in visuospatial ability in dyslexia

Conflicting empirical and theoretical accounts suggest that dyslexia is associated with either average, enhanced, or impoverished high-level visuospatial processing relative to controls. Such heterogeneous results could be due to the presence of wider variability in dyslexic samples, which is unlikely to be identified at the single study level, due to lack of power. To address this, this study reports a meta-analysis of means and variances in high-level visuospatial ability in 909 non-dyslexic and 956 dyslexic individuals. The findings suggest that dyslexia is associated not only with a lower mean performance on visuospatial tasks but also with greater variability in performance. Through novel meta-analytic techniques, we demonstrate a negative effect size for mean differences (-.457), but a positive effect size for SD differences (+.118; SD ratio = 1.107). In doing so, this is the first study to demonstrate impoverished visuospatial processing of the majority of individuals with dyslexia in addition to greater variance in performance in this group. The findings advocate for further consideration of both the presence of, and reasons for, increased variance in perception, attention, and memory across neurodevelopmental disorders.

Shared and Unique Risk Factors Underlying Mathematical Disability and Reading and Spelling Disability

High comorbidity rates have been reported between mathematical learning disabilities (MD) and reading and spelling disabilities (RSD). Research has identified skills related to math, such as number sense (NS) and visuospatial working memory (visuospatial WM), as well as to literacy, such as phonological awareness (PA), rapid automatized naming (RAN) and verbal short-term memory (Verbal STM). In order to explain the high comorbidity rates between MD and RSD, 7–11-year-old children were assessed on a range of cognitive abilities related to literacy (PA, RAN, Verbal STM) and mathematical ability (visuospatial WM, NS). The group of children consisted of typically developing (TD) children (n = 32), children with MD (n = 26), children with RSD (n = 29), and combined MD and RSD (n = 43). It was hypothesized that, in line with the multiple deficit view on learning disorders, at least one unique predictor for both MD and RSD and a possible shared cognitive risk factor would be found to account for the comorbidity between the symptom dimensions literacy and math. Secondly, our hypotheses were that (a) a probabilistic multi-factorial risk factor model would provide a better fit to the data than a deterministic single risk factor model and (b) that a shared risk factor model would provide a better fit than the specific multi-factorial model. All our hypotheses were confirmed. NS and visuospatial WM were identified as unique cognitive predictors for MD, whereas PA and RAN were both associated with RSD. Also, a shared risk factor model with PA as a cognitive predictor for both RSD and MD fitted the data best, indicating that MD and RSD might co-occur due to a shared underlying deficit in phonological processing. Possible explanations are discussed in the context of sample selection and composition. This study shows that different cognitive factors play a role in mathematics and literacy, and that a phonological processing deficit might play a role in the occurrence of MD and RSD.

Cross-Language Modulation of Visual Attention Span: An Arabic-French-Spanish Comparison in Skilled Adult Readers

In delineating the amount of orthographic information that can be processed in parallel during a single fixation, the visual attention (VA) span acts as a key component of the reading system. Previous studies focused on the contribution of VA span to normal and pathological reading in monolingual and bilingual children from different European languages, without direct cross-language comparison. In the current paper, we explored modulations of VA span abilities in three languages –French, Spanish, and Arabic– that differ in transparency, reading direction and writing systems. The participants were skilled adult readers who were native speakers of French, Spanish or Arabic. They were administered tasks of global and partial letter report, single letter identification and text reading. Their VA span abilities were assessed using tasks that require the processing of briefly presented five consonant strings (e.g., R S H F T). All five consonants had to be reported in global report but a single cued letter in partial report. Results showed that VA span was reduced in Arabic readers as compared to French or Spanish readers who otherwise show a similar high performance in the two report tasks. The analysis of VA span response patterns in global report showed a left-right asymmetry in all three languages. A leftward letter advantage was found in French and Spanish but a rightward advantage in Arabic. The response patterns were symmetric in partial report, regardless of the language. Last, a significant relationship was found between VA span abilities and reading speed but only for French. The overall findings suggest that the size of VA span, the shape of VA span response patterns and the VA Span-reading relationship are modulated by language-specific features.

High Reading Skills Mask Dyslexia in Gifted Children

This study investigated how gifted children with dyslexia might be able to mask literacy problems and the role of possible compensatory mechanisms. The sample consisted of 121 Dutch primary school children that were divided over four groups (typically developing [TD] children, children with dyslexia, gifted children, gifted children with dyslexia). The test battery included measures of literacy (reading/spelling) and cognitive abilities related to literacy and language (phonological awareness [PA], rapid automatized naming [RAN], verbal short-term memory [VSTM], working memory [WM], grammar, and vocabulary). It was hypothesized that gifted children with dyslexia would outperform children with dyslexia on literacy tests. In addition, a core-deficit model including dyslexia-related weaknesses and a compensational model involving giftedness-related strengths were tested using Bayesian statistics to explain their reading/spelling performance. Gifted children with dyslexia performed on all literacy tests in between children with dyslexia and TD children. Their cognitive profile showed signs of weaknesses in PA and RAN and strengths in VSTM, WM, and language skills. Findings indicate that phonology is a risk factor for gifted children with dyslexia, but this is moderated by other skills such as WM, grammar, and vocabulary, providing opportunities for compensation of a cognitive deficit and masking of literacy difficulties.

Neurocognitive Development and Predictors of L1 and L2 Literacy Skills in Dyslexia: A Longitudinal Study of Children 5-11 Years Old

The aim of this study was to find valid neurocognitive precursors of literacy development in first language (L1, Norwegian) and second language (L2, English) in a group of children during their Pre-literacy, Emergent Literacy and Literacy stages, by comparing children with dyslexia and a typical group. Children who were 5 years old at project start were followed until the age of 11, when dyslexia was identified and data could be analysed in retrospect. The children's neurocognitive pattern changed both by literacy stage and domain. Visuo-spatial recall and RAN appeared as early precursors of L1 literacy, while phonological awareness appeared as early precursor of L2 English. Verbal long term memory was associated with both L1 and L2 skills in the Literacy stage. Significant group differences seen in the Pre-literacy and Emergent literacy stages decreased in the Literacy stage. The developmental variations by stage and domain may explain some of the inconsistencies seen in dyslexia research. Early identification and training are essential to avoid academic failure, and our data show that visuo-spatial memory and RAN could be suitable early markers in transparent orthographies like Norwegian. Phonological awareness was here seen as an early precursor of L2 English, but not of L1 Norwegian.

Orthographic processing deficits in developmental dyslexia: Beyond the ventral visual stream

Fast effortless reading has been associated with the Visual Word Form Area (VWFA), a region in the ventral visual stream that specializes in the recognition of letter strings. Several neuroimaging studies of dyslexia revealed an underactivation of this region. However, most of these studies used reading tasks and/or were carried out on adults. Given that fluent reading is severely impaired in dyslexics, any underactivation might simply reflect a well-established reading deficit in impaired readers and could be the consequence rather than the cause of dyslexia. Here, we designed a task that does not rely on reading per se but that tapped early visual orthographic processing that forms the basis of reading. Dyslexic children aged 8-12years and age-matched controls were asked to search for letters, digits, and symbols in 5-element strings (Experiment 1). This novel task was complemented by a classic task known to activate the VWFA, namely the passive viewing of pseudowords and falsefonts (Experiment 2). We found that in addition to significant group differences in the VWFA, dyslexic children showed a significant underactivation of the middle occipital gyrus (MOG) relative to the control group. Several areas in the MOG are known for their engagement in visuospatial processing, and it has been proposed that the MOG is necessary for ordering the symbols in unfamiliar strings. Our results suggest that the VWFA deficit might be secondary to an impairment of visuospatial processing in the MOG. We argue that efficient processing in MOG in the course of reading acquisition is critical for the development of effortless fast visual word recognition in the VWFA.

Morphological differences in the lateral geniculate nucleus associated with dyslexia

Developmental dyslexia is a common learning disability characterized by normal intelligence but difficulty in skills associated with reading, writing and spelling. One of the most prominent, albeit controversial, theories of dyslexia is the magnocellular theory, which suggests that malfunction of the magnocellular system in the brain is responsible for the behavioral deficits. We sought to test the basis of this theory by directly measuring the lateral geniculate nucleus (LGN), the only location in the brain where the magnocellular and parvocellular streams are spatially disjoint. Using high-resolution proton-density weighted MRI scans, we precisely measured the anatomical boundaries of the LGN in 13 subjects with dyslexia (five female) and 13 controls (three female), all 22–26 years old. The left LGN was significantly smaller in volume in subjects with dyslexia and also differed in shape; no differences were observed in the right LGN. The functional significance of this asymmetry is unknown, but these results are consistent with the magnocellular theory and support theories of dyslexia that involve differences in the early visual system.

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The first direct test of the magnocellular hypothesis of dyslexia in vivo

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The first measurements of the LGN in living subjects with dyslexia

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The LGN are smaller in subjects with dyslexia and differ morphologically

Does pronounceability modulate the letter string deficit of children with dyslexia? A study with the rate and amount model

The locus of the deficit of children with dyslexia in dealing with strings of letters may be a deficit at a pre-lexical graphemic level or an inability to bind orthographic and phonological information. We evaluate these alternative hypotheses in two experiments by examining the role of stimulus pronounceability in a lexical decision task (LDT) and in a forced-choice letter discrimination task (Reicher-Wheeler paradigm). Seventeen fourth grade children with dyslexia and 24 peer control readers participated to two experiments. In the LDT children were presented with high-, low-frequency words, pronounceable pseudowords (such as DASU) and unpronounceable non-words (such as RNGM) of 4-, 5-, or 6- letters. No sign of group by pronounceability interaction was found when over-additivity was taken into account. Children with dyslexia were impaired when they had to process strings, not only of pronounceable stimuli but also of unpronounceable stimuli, a deficit well accounted for by a single global factor. Complementary results were obtained with the Reicher-Wheeler paradigm: both groups of children gained in accuracy in letter discrimination in the context of pronounceable primes (words and pseudowords) compared to unpronounceable primes (non-words). No global factor was detected in this task which requires the discrimination between a target letter and a competitor but does not involve simultaneous letter string processing. Overall, children with dyslexia show a selective difficulty in simultaneously processing a letter string as a whole, independent of its pronounceability; however, when the task involves isolated letter processing, also these children can make use of the ortho-phono-tactic information derived from a previously seen letter string. This pattern of findings is in keeping with the idea that an impairment in pre-lexical graphemic analysis may be a core deficit in developmental dyslexia.

Modeling individual differences in text reading fluency: a different pattern of predictors for typically developing and dyslexic readers

This study was aimed at predicting individual differences in text reading fluency. The basic proposal included two factors, i.e., the ability to decode letter strings (measured by discrete pseudo-word reading) and integration of the various sub-components involved in reading (measured by Rapid Automatized Naming, RAN). Subsequently, a third factor was added to the model, i.e., naming of discrete digits. In order to use homogeneous measures, all contributing variables considered the entire processing of the item, including pronunciation time. The model, which was based on commonality analysis, was applied to data from a group of 43 typically developing readers (11- to 13-year-olds) and a group of 25 chronologically matched dyslexic children. In typically developing readers, both orthographic decoding and integration of reading sub-components contributed significantly to the overall prediction of text reading fluency. The model prediction was higher (from ca. 37 to 52% of the explained variance) when we included the naming of discrete digits variable, which had a suppressive effect on pseudo-word reading. In the dyslexic readers, the variance explained by the two-factor model was high (69%) and did not change when the third factor was added. The lack of a suppression effect was likely due to the prominent individual differences in poor orthographic decoding of the dyslexic children. Analyses on data from both groups of children were replicated by using patches of colors as stimuli (both in the RAN task and in the discrete naming task) obtaining similar results. We conclude that it is possible to predict much of the variance in text-reading fluency using basic processes, such as orthographic decoding and integration of reading sub-components, even without taking into consideration higher-order linguistic factors such as lexical, semantic and contextual abilities. The approach validity of using proximal vs. distal causes to predict reading fluency is discussed.

TVA-based assessment of visual attentional functions in developmental dyslexia

There is an ongoing debate whether an impairment of visual attentional functions constitutes an additional or even an isolated deficit of developmental dyslexia (DD). Especially performance in tasks that require the processing of multiple visual elements in parallel has been reported to be impaired in DD. We review studies that used parameter-based assessment for identifying and quantifying impaired aspect(s) of visual attention that underlie this multi-element processing deficit in DD. These studies used the mathematical framework provided by the "theory of visual attention" (Bundesen, 1990) to derive quantitative measures of general attentional resources and attentional weighting aspects on the basis of behavioral performance in whole- and partial-report tasks. Based on parameter estimates in children and adults with DD, the reviewed studies support a slowed perceptual processing speed as an underlying primary deficit in DD. Moreover, a reduction in visual short term memory storage capacity seems to present a modulating component, contributing to difficulties in written language processing. Furthermore, comparing the spatial distributions of attentional weights in children and adults suggests that having limited reading and writing skills might impair the development of a slight leftward bias, that is typical for unimpaired adult readers.

The phonological and visual basis of developmental dyslexia in Brazilian Portuguese reading children

Evidence from opaque languages suggests that visual attention processing abilities in addition to phonological skills may act as cognitive underpinnings of developmental dyslexia. We explored the role of these two cognitive abilities on reading fluency in Brazilian Portuguese, a more transparent orthography than French or English. Sixty-six children with developmental dyslexia and normal Brazilian Portuguese children participated. They were administered three tasks of phonological skills (phoneme identification, phoneme, and syllable blending) and three visual tasks (a letter global report task and two non-verbal tasks of visual closure and visual constancy). Results show that Brazilian Portuguese children with developmental dyslexia are impaired not only in phonological processing but further in visual processing. The phonological and visual processing abilities significantly and independently contribute to reading fluency in the whole population. Last, different cognitively homogeneous subtypes can be identified in the Brazilian Portuguese population of children with developmental dyslexia. Two subsets of children with developmental dyslexia were identified as having a single cognitive disorder, phonological or visual; another group exhibited a double deficit and a few children showed no visual or phonological disorder. Thus the current findings extend previous data from more opaque orthographies as French and English, in showing the importance of investigating visual processing skills in addition to phonological skills in children with developmental dyslexia whatever their language orthography transparency.

Visual processing of multiple elements in the dyslexic brain: evidence for a superior parietal dysfunction

The visual attention (VA) span deficit hypothesis of developmental dyslexia posits that impaired multiple element processing can be responsible for poor reading outcomes. In VA span impaired dyslexic children, poor performance on letter report tasks is associated with reduced parietal activations for multiple letter processing. While this hints towards a non-specific, attention-based dysfunction, it is still unclear whether reduced parietal activity generalizes to other types of stimuli. Furthermore, putative links between reduced parietal activity and reduced ventral occipito-temporal (vOT) in dyslexia have yet to be explored. Using functional magnetic resonance imaging, we measured brain activity in 12 VA span impaired dyslexic adults and 12 adult skilled readers while they carried out a categorization task on single or multiple alphanumeric or non-alphanumeric characters. While healthy readers activated parietal areas more strongly for multiple than single element processing (right-sided for alphanumeric and bilateral for non-alphanumeric), similar stronger multiple element right parietal activations were absent for dyslexic participants. Contrasts between skilled and dyslexic readers revealed significantly reduced right superior parietal lobule (SPL) activity for dyslexic readers regardless of stimuli type. Using a priori anatomically defined regions of interest, we showed that neural activity was reduced for dyslexic participants in both SPL and vOT bilaterally. Finally, we used multiple regressions to test whether SPL activity was related to vOT activity in each group. In the left hemisphere, SPL activity covaried with vOT activity for both normal and dyslexic readers. In contrast, in the right hemisphere, SPL activity covaried with vOT activity only for dyslexic readers. These results bring critical support to the VA interpretation of the VA Span deficit. In addition, they offer a new insight on how deficits in automatic vOT based word recognition could arise in developmental dyslexia.

New insights on developmental dyslexia subtypes: heterogeneity of mixed reading profiles

We examined whether classifications based on reading performance are relevant to identify cognitively homogeneous subgroups of dyslexic children. Each of the 71 dyslexic participants was selected to have a mixed reading profile, i.e. poor irregular word and pseudo-word reading performance (accuracy and speed). Despite their homogeneous reading profile, the participants were found to split into four distinct cognitive subgroups, characterized by a single phonological disorder, a single visual attention span disorder, a double deficit or none of these disorders. The two subgroups characterized by single and contrasted cognitive disorders were found to exhibit a very similar reading pattern but more contrasted spelling performance (quantitative analysis). A qualitative analysis of the error types produced in reading and spelling provided some cues about the participants' underlying cognitive deficit. The overall findings disqualify subtyping based on reading profiles as a classification method to identify cognitively homogeneous subgroups of dyslexic children. They rather show an opaque relationship between the cognitive underpinnings of developmental dyslexia and their behavioral manifestations in reading and spelling. Future neuroimaging and genetic studies should take this issue into account since synthesizing over cognitively heterogeneous children would entail potential pitfalls.

Does visual attention span relate to eye movements during reading and copying?

This research investigated whether text reading and copying involve visual attention-processing skills. Children in grades 3 and 5 read and copied the same text. We measured eye movements while reading and the number of gaze lifts (GL) during copying. The children were also administered letter report tasks that constitute an estimation of the number of letters that are processed simultaneously. The tasks were designed to assess visual attention span abilities (VA). The results for both grades revealed that the children who reported more letters, i.e., processed more consonants in parallel, produced fewer rightward fixations during text reading suggesting they could process more letters at each fixation. They also copied more letters per gaze lift from the same text. Furthermore, a regression analysis showed that VA span predicted variations in copying independently of the influence of reading skills. The findings support a role of VA span abilities in the early extraction of orthographic information, for both reading and copying tasks.

Intervention for a multi-character processing deficit in a Greek-speaking child with surface dyslexia

A case study with a 12-year-old boy, R.F., who was a monolingual speaker of Greek is reported. R.F. showed slow word reading and a difficulty in spelling irregular words but not nonwords. Assessments revealed that R.F. did not appear to have a phonological deficit, but indicated impaired multicharacter processing ability for visually presented letter arrays. On the basis of previous research linking multicharacter processing and reading we developed an intervention aimed at improving R.F.'s ability to report letter arrays of increasing length. Following a 9-week programme, improvement was observed, and investigation of R.F.'s reading revealed gains in single word reading speed and accuracy. The findings support the significance of intervention studies for testing hypotheses regarding causal relationships among cognitive processes and the notion of specific profiles of developmental dyslexia/dysgraphia in both opaque and transparent orthographies.

Developmental dyslexia: exploring how much phonological and visual attention span disorders are linked to simultaneous auditory processing deficits

The simultaneous auditory processing skills of 17 dyslexic children and 17 skilled readers were measured using a dichotic listening task. Results showed that the dyslexic children exhibited difficulties reporting syllabic material when presented simultaneously. As a measure of simultaneous visual processing, visual attention span skills were assessed in the dyslexic children. We presented the dyslexic children with a phonological short-term memory task and a phonemic awareness task to quantify their phonological skills. Visual attention spans correlated positively with individual scores obtained on the dichotic listening task while phonological skills did not correlate with either dichotic scores or visual attention span measures. Moreover, all the dyslexic children with a dichotic listening deficit showed a simultaneous visual processing deficit, and a substantial number of dyslexic children exhibited phonological processing deficits whether or not they exhibited low dichotic listening scores. These findings suggest that processing simultaneous auditory stimuli may be impaired in dyslexic children regardless of phonological processing difficulties and be linked to similar problems in the visual modality.

Eye-voice span during rapid automatized naming of digits and dice in Chinese normal and dyslexic children

We measured Chinese dyslexic and control children's eye movements during rapid automatized naming (RAN) with alphanumeric (digits) and symbolic (dice surfaces) stimuli. Both types of stimuli required identical oral responses, controlling for effects associated with speech production. Results showed that naming dice was much slower than naming digits for both groups, but group differences in eye-movement measures and in the eye-voice span (i.e. the distance between the currently fixated item and the voiced item) were generally larger in digit-RAN than in dice-RAN. In addition, dyslexics were less efficient in parafoveal processing in these RAN tasks. Since the two RAN tasks required the same phonological output and on the assumption that naming dice is less practiced than naming digits in general, the results suggest that the translation of alphanumeric visual symbols into phonological codes is less efficient in dyslexic children. The dissociation of the print-to-sound conversion and phonological representation suggests that the degree of automaticity in translation from visual symbols to phonological codes in addition to phonological processing per se is also critical to understanding dyslexia.

The role of visual processing speed in reading speed development

A steady increase in reading speed is the hallmark of normal reading acquisition. However, little is known of the influence of visual attention capacity on children's reading speed. The number of distinct visual elements that can be simultaneously processed at a glance (dubbed the visual attention span), predicts single-word reading speed in both normal reading and dyslexic children. However, the exact processes that account for the relationship between the visual attention span and reading speed remain to be specified. We used the Theory of Visual Attention to estimate visual processing speed and visual short-term memory capacity from a multiple letter report task in eight and nine year old children. The visual attention span and text reading speed were also assessed. Results showed that visual processing speed and visual short term memory capacity predicted the visual attention span. Furthermore, visual processing speed predicted reading speed, but visual short term memory capacity did not. Finally, the visual attention span mediated the effect of visual processing speed on reading speed. These results suggest that visual attention capacity could constrain reading speed in elementary school children.

Effect of orthographic processes on letter identity and letter-position encoding in dyslexic children

The ability to identify letters and encode their position is a crucial step of the word recognition process. However and despite their word identification problem, the ability of dyslexic children to encode letter identity and letter-position within strings was not systematically investigated. This study aimed at filling this gap and further explored how letter identity and letter-position encoding is modulated by letter context in developmental dyslexia. For this purpose, a letter-string comparison task was administered to French dyslexic children and two chronological age (CA) and reading age (RA)-matched control groups. Children had to judge whether two successively and briefly presented four-letter strings were identical or different. Letter-position and letter identity were manipulated through the transposition (e.g., RTGM vs. RMGT) or substitution of two letters (e.g., TSHF vs. TGHD). Non-words, pseudo-words, and words were used as stimuli to investigate sub-lexical and lexical effects on letter encoding. Dyslexic children showed both substitution and transposition detection problems relative to CA-controls. A substitution advantage over transpositions was only found for words in dyslexic children whereas it extended to pseudo-words in RA-controls and to all type of items in CA-controls. Letters were better identified in the dyslexic group when belonging to orthographically familiar strings. Letter-position encoding was very impaired in dyslexic children who did not show any word context effect in contrast to CA-controls. Overall, the current findings point to a strong letter identity and letter-position encoding disorder in developmental dyslexia.