Perception of voice and tone onset time continua in children with dyslexia with and without attention deficit/hyperactivity disorder

Combined multi-session transcranial alternating current stimulation (tACS) and language skills training improves individual gamma band activity and literacy skills in developmental dyslexia

Developmental dyslexia is characterized by the pathologically diminished ability to acquire reading and spelling skills. Accurate processing of acoustic information at the phonemic scale is crucial for successful sound-to-letter-mapping which, in turn, is elemental in reading and spelling. Altered activation patterns in the auditory cortex are thought to provide the neurophysiological basis for the inaccurate phonemic perception. Recently, transcranial electrical stimulation has been shown to be an effective method to ameliorate cortical activation patterns in the auditory cortex. In a sample of children and adolescents with dyslexia, we investigated the effect of multi-session transcranial alternating current stimulation delivered concurrently with a phonological training and in combination with a behavioral literacy skills training. Over a 5-week period the participants received 10 training sessions while gamma-tACS was administered over bilateral auditory cortex. We found that gamma-tACS shifted the peak frequency of auditory gamma oscillations reflecting a more fine-grained processing of time-critical acoustic information. This amelioration was accompanied by increased phonemic processing skills. Moreover, individuals who received gamma-tACS showed significant improvements in their spelling skills four months after the intervention. Our results demonstrate that multi-session gamma-tACS enhances the effects of a behavioral intervention and induces long-term improvement on literacy skills in dyslexia.

Modulation of auditory temporal processing, speech in noise perception, auditory-verbal memory, and reading efficiency by anodal tDCS in children with dyslexia

Dyslexia is a neurodevelopmental disorder that is prevalent in children. It is estimated that 30-50% of individuals diagnosed with dyslexia also manifest an auditory perceptual deficit characteristic of auditory processing disorder (APD). Some studies suggest that defects in basic auditory processing can lead to phonological defects as the most prominent cause of dyslexia. Thus, in some cases, there may be interrelationships between dyslexia and some of the aspects of central auditory processing. In recent years, transcranial direct current stimulation (tDCS) has been used as a safe method for the modulation of central auditory processing aspects in healthy adults and reading skills in children with dyslexia. Therefore, the objectives of our study were to investigate the effect of tDCS on the modulation of different aspects of central auditory processing, aspects of reading, and the relationship between these two domains in dyslexic children with APD. A within-subjects design was employed to investigate the effect of two electrode arrays (the anode on the left STG (AC)/cathode on the right shoulder and anode on the left STG/cathode on the right STG) on auditory temporal processing; speech-in-noise perception, short-term auditory memory; and high-frequency word, low-frequency word, pseudoword, and text reading. The results of this clinical trial showed the modulation of the studied variables in central auditory processing and the accuracy and speed of reading variables compared to the control and sham statuses in both electrode arrays. Our results also showed that the improvement of the accuracy and speed of text reading, as well as the accuracy of pseudoword reading were related to the improvement of speech in noise perception and temporal processing. The results of this research can be effective in clarifying the basis of the neurobiology of dyslexia and, in particular, the hypothesis of the role of basic auditory processing and subsequently the role of the auditory cortex in dyslexia. These results might provide a framework to facilitate behavioral rehabilitation in dyslexic children with APD.

Reconsidering commonly used stimuli in speech perception experiments

This paper examines some commonly used stimuli in speech perception experiments and raises questions about their use, or about the interpretations of previous results. The takeaway messages are: 1) the Hillenbrand vowels represent a particular dialect rather than a gold standard, and English vowels contain spectral dynamics that have been largely underappreciated, 2) the /ɑ/ context is very common but not clearly superior as a context for testing consonant perception, 3) /ɑ/ is particularly problematic when testing voice-onset-time perception because it introduces strong confounds in the formant transitions, 4) /dɑ/ is grossly overrepresented in neurophysiological studies and yet is insufficient as a generalized proxy for "speech perception," and 5) digit tests and matrix sentences including the coordinate response measure are systematically insensitive to important patterns in speech perception. Each of these stimulus sets and concepts is described with careful attention to their unique value and also cases where they might be misunderstood or over-interpreted.

Distinct neuronal types contribute to hybrid temporal encoding strategies in primate auditory cortex

Studies of the encoding of sensory stimuli by the brain often consider recorded neurons as a pool of identical units. Here, we report divergence in stimulus-encoding properties between subpopulations of cortical neurons that are classified based on spike timing and waveform features. Neurons in auditory cortex of the awake marmoset (Callithrix jacchus) encode temporal information with either stimulus-synchronized or nonsynchronized responses. When we classified single-unit recordings using either a criteria-based or an unsupervised classification method into regular-spiking, fast-spiking, and bursting units, a subset of intrinsically bursting neurons formed the most highly synchronized group, with strong phase-locking to sinusoidal amplitude modulation (SAM) that extended well above 20 Hz. In contrast with other unit types, these bursting neurons fired primarily on the rising phase of SAM or the onset of unmodulated stimuli, and preferred rapid stimulus onset rates. Such differentiating behavior has been previously reported in bursting neuron models and may reflect specializations for detection of acoustic edges. These units responded to natural stimuli (vocalizations) with brief and precise spiking at particular time points that could be decoded with high temporal stringency. Regular-spiking units better reflected the shape of slow modulations and responded more selectively to vocalizations with overall firing rate increases. Population decoding using time-binned neural activity found that decoding behavior differed substantially between regular-spiking and bursting units. A relatively small pool of bursting units was sufficient to identify the stimulus with high accuracy in a manner that relied on the temporal pattern of responses. These unit type differences may contribute to parallel and complementary neural codes.

Neurons in auditory cortex show highly diverse responses to sounds. This study suggests that neuronal type inferred from baseline firing properties accounts for much of this diversity, with a subpopulation of bursting units being specialized for precise temporal encoding.

Temporal processing deficit in children with attention-deficit/hyperactivity disorder: An online assessment

Objective

Temporal processing deficits were found among children with attention-deficit/hyperactivity disorder (ADHD). The present study aims to develop an online temporal processing assessment that can be conducted remotely, and the sensitivity of the test was assessed on a group of children with ADHD.

Methods

A total of 188 children were recruited, including 94 typically developing (TD) children, and 94 children with ADHD. The online assessment consists of two temporal-order judgment (TOJ) tasks. One task used tone pairs presented with two interstimulus intervals (ISIs) (305ms and 40ms). Another task used pairs of consonant-vowel (CV) syllables with 20 varying ISI levels. Participants were asked to determine the sequence of the sound pairs.

Results

The results showed that ADHD children were less accurate (ISI 305ms: M = 83.90%; ISI 40ms: M = 66.28%) than TD children (ISI 305ms: M = 89.36%; ISI 40ms: M = 77.16%) in the tone task. Similarly, ADHD children showed a higher ISI passing threshold (M = 283.64ms) than TD children (M = 199.76ms) and higher accuracy in the CV task. Hierarchical binary logistic regression suggested a model to predict ADHD children using accuracy in ISI 40ms in the tone task and ISI passing threshold in the CV task. Receiver operating characteristic (ROC) analysis yielded a sensitivity of 75.58% and a specificity of 51.11%.

Conclusion

ADHD children showed temporal processing deficits of both tones and CVs. The online assessment may be a valid tool for differentiating ADHD children from TD children.

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.

Dysfunctional auditory gamma oscillations in developmental dyslexia: A potential target for a tACS-based intervention

Interventions in developmental dyslexia typically consist of orthography-based reading and writing trainings. However, their efficacy is limited and, consequently, the symptoms persist into adulthood. Critical for this lack of efficacy is the still ongoing debate about the core deficit in dyslexia and its underlying neurobiological causes. There is ample evidence on phonological as well as auditory temporal processing deficits in dyslexia and, on the other hand, cortical gamma oscillations in the auditory cortex as functionally relevant for the extraction of linguistically meaningful information units from the acoustic signal. The present work aims to shed more light on the link between auditory gamma oscillations, phonological awareness, and literacy skills in dyslexia. By mean of EEG, individual gamma frequencies were assessed in a group of children and adolescents diagnosed with dyslexia as well as in an age-matched control group with typical literacy skills. Furthermore, phonological awareness was assessed in both groups, while in dyslexic participants also reading and writing performance was measured. We found significantly lower gamma peak frequencies as well as lower phonological awareness scores in dyslexic participants compared to age-matched controls. Additionally, results showed a positive correlation between the individual gamma frequency and phonological awareness. Our data suggest a hierarchical structure of neural gamma oscillations, phonological awareness, and literacy skills. Thereby, the results emphasize altered gamma oscillation not only as a core deficit in dyslexia but also as a potential target for future causal interventions. We discuss these findings considering non-invasive brain stimulation techniques and suggest transcranial alternating current stimulation as a promising approach to normalize dysfunctional oscillations in dyslexia.

Differential activation of the visual word form area during auditory phoneme perception in youth with dyslexia

Developmental dyslexia is a learning disorder characterized by difficulties reading words accurately and/or fluently. Several behavioral studies have suggested the presence of anomalies at an early stage of phoneme processing, when the complex spectrotemporal patterns in the speech signal are analyzed and assigned to phonemic categories. In this study, fMRI was used to compare brain responses associated with categorical discrimination of speech syllables (P) and acoustically matched nonphonemic stimuli (N) in children and adolescents with dyslexia and in typically developing (TD) controls, aged 8-17 years. The TD group showed significantly greater activation during the P condition relative to N in an area of the left ventral occipitotemporal cortex that corresponds well with the region referred to as the "visual word form area" (VWFA). Regression analyses using reading performance as a continuous variable across the full group of participants yielded similar results. Overall, the findings are consistent with those of previous neuroimaging studies using print stimuli in individuals with dyslexia that found reduced activation in left occipitotemporal regions; however, the current study shows that these activation differences seen during reading are apparent during auditory phoneme discrimination in youth with dyslexia, suggesting that the primary deficit in at least a subset of children may lie early in the speech processing stream and that categorical perception may be an important target of early intervention in children at risk for dyslexia.

Categorical phoneme labeling in children with dyslexia does not depend on stimulus duration

It is established that individuals with dyslexia are less consistent at auditory phoneme categorization than typical readers. One hypothesis attributes these differences in phoneme labeling to differences in auditory cue integration over time, suggesting that the performance of individuals with dyslexia would improve with longer exposure to informative phonetic cues. Here, the relationship between phoneme labeling and reading ability was investigated while manipulating the duration of steady-state auditory information available in a consonant-vowel syllable. Children with dyslexia obtained no more benefit from longer cues than did children with typical reading skills, suggesting that poor task performance is not explained by deficits in temporal integration or temporal sampling.

Reading ability and phoneme categorization

Dyslexia is associated with abnormal performance on many auditory psychophysics tasks, particularly those involving the categorization of speech sounds. However, it is debated whether those apparent auditory deficits arise from (a) reduced sensitivity to particular acoustic cues, (b) the difficulty of experimental tasks, or (c) unmodeled lapses of attention. Here we investigate the relationship between phoneme categorization and reading ability, with special attention to the nature of the cue encoding the phoneme contrast (static versus dynamic), differences in task paradigm difficulty, and methodological details of psychometric model fitting. We find a robust relationship between reading ability and categorization performance, show that task difficulty cannot fully explain that relationship, and provide evidence that the deficit is not restricted to dynamic cue contrasts, contrary to prior reports. Finally, we demonstrate that improved modeling of behavioral responses suggests that performance does differ between children with dyslexia and typical readers, but that the difference may be smaller than previously reported.

Auditory temporal processing, reading, and phonological awareness among aging adults

Auditory temporal processing (ATP) has been related in the literature to both speech perception as well as reading and phonological awareness. In aging adults, it is known to be related to difficulties in speech perception. In the present study, we aimed to test whether an age-related deficit in ATP would also be accompanied by poor reading and phonological awareness. Thirty-eight aging adults were compared to 55 readers with dyslexia and 42 young normal readers on temporal order judgment (TOJ), speech perception, reading, and phonological awareness tests. Aging adults had longer TOJ thresholds than young normal readers, but shorter than readers with dyslexia; however, they had lower speech perception accuracy than both groups. Phonological awareness of the aging adults was better than readers with dyslexia, but poorer than young normal readers, although their reading accuracy was similar to that of the young controls. This is the first report on poor phonological awareness among aging adults. Suprisingly, it was not accompanied by difficulties in reading ability, and might instead be related to aging adults' difficulties in speech perception. This newly discovered relationship between ATP and phonological awareness among aging adults appears to extend the existing understanding of this relationship, and suggests it should be explored in other groups with ATP deficits.

Dyslexia as a multi-deficit disorder: Working memory and auditory temporal processing

Dyslexia is difficulty in acquiring reading skills despite adequate intelligence and sufficient reading opportunities. Its origin is still under debate. Studies usually focus on a singular cause for dyslexia; however, some researchers argue that dyslexia reflects multiple deficits. Two of the abilities under investigation in dyslexia are working memory (WM) and auditory temporal processing (ATP). In order to better evaluate the relative roles of WM and ATP in dyslexia, in the present study, we tested the contribution of WM and ATP to different types of reading performance and phonological awareness in dyslexia, using a multidimensional approach. Seventy-eight adults with dyslexia and 23 normal-reading adults performed WM and ATP tasks, as well as reading and phonological awareness tests. Readers with dyslexia showed poorer performance on all tests. Both WM and ATP were significant predictors of reading performance and phonological awareness among participants with dyslexia. Dividing participants with dyslexia according to their performance level on WM and ATP tasks revealed group differences in reading and phonological awareness tests. Both WM and ATP contribute to dyslexia, and varying levels of difficulties in both of these abilities are observed among this population. This is strong evidence in favor of the multi-deficit approach in dyslexia, and suggests that researchers should consider this approach in future studies of dyslexia.

Transcranial Random Noise Stimulation (tRNS) Shapes the Processing of Rapidly Changing Auditory Information

Neural oscillations in the gamma range are the dominant rhythmic activation pattern in the human auditory cortex. These gamma oscillations are functionally relevant for the processing of rapidly changing acoustic information in both speech and non-speech sounds. Accordingly, there is a tight link between the temporal resolution ability of the auditory system and inherent neural gamma oscillations. Transcranial random noise stimulation (tRNS) has been demonstrated to specifically increase gamma oscillation in the human auditory cortex. However, neither the physiological mechanisms of tRNS nor the behavioral consequences of this intervention are completely understood. In the present study we stimulated the human auditory cortex bilaterally with tRNS while EEG was continuously measured. Modulations in the participants’ temporal and spectral resolution ability were investigated by means of a gap detection task and a pitch discrimination task. Compared to sham, auditory tRNS increased the detection rate for near-threshold stimuli in the temporal domain only, while no such effect was present for the discrimination of spectral features. Behavioral findings were paralleled by reduced peak latencies of the P50 and N1 component of the auditory event-related potentials (ERP) indicating an impact on early sensory processing. The facilitating effect of tRNS was limited to the processing of near-threshold stimuli while stimuli clearly below and above the individual perception threshold were not affected by tRNS. This non-linear relationship between the signal-to-noise level of the presented stimuli and the effect of stimulation further qualifies stochastic resonance (SR) as the underlying mechanism of tRNS on auditory processing. Our results demonstrate a tRNS related improvement in acoustic perception of time critical auditory information and, thus, provide further indices that auditory tRNS can amplify the resonance frequency of the auditory system.

The Role of Categorical Speech Perception and Phonological Processing in Familial Risk Children With and Without Dyslexia

PURPOSE

This study assessed whether a categorical speech perception (CP) deficit is associated with dyslexia or familial risk for dyslexia, by exploring a possible cascading relation from speech perception to phonology to reading and by identifying whether speech perception distinguishes familial risk (FR) children with dyslexia (FRD) from those without dyslexia (FRND).

METHOD

Data were collected from 9-year-old FRD (n = 37) and FRND (n = 41) children and age-matched controls (n = 49) on CP identification and discrimination and on the phonological processing measures rapid automatized naming, phoneme awareness, and nonword repetition.

RESULTS

The FRD group performed more poorly on CP than the FRND and control groups. Findings on phonological processing align with the literature in that (a) phonological processing related to reading and (b) the FRD group showed the lowest phonological processing outcomes. Furthermore, CP correlated weakly with reading, but this relationship was fully mediated by rapid automatized naming.

CONCLUSION

Although CP phonological skills are related to dyslexia, there was no strong evidence for a cascade from CP to phonology to reading. Deficits in CP at the behavioral level are not directly associated with dyslexia.

Neural Mechanisms of Language-Based Learning Impairments: Insights from Human Populations and Animal Models

The acquisition of speech perception and consequent expression of language represent fundamental aspects of human functioning. Yet roughly 7% to 8% of children who are otherwise healthy and of normal intelligence exhibit unexplained delays and impairments in acquiring these skills. Ongoing research has revealed several key features of language disability that may pro-vide more direct insight into underlying anomalous neural functioning. For example, evidence supports a strong association between basic defects in processing rapidly changing acoustic information and emergent disruptions in speech perception, as well as cascading effects on other forms of language development (including reading). Considerable neurobiological research has thus focused on developmental factors that might deleteriously influence rapid sensory processing. Additional research focuses on mechanisms of neural plasticity, including how such brains might be “retrained” for improved processing of language. These and related findings from human clinical studies, electrophysiological studies, neuroimaging studies, and animal models are reviewed.

Relationships between Categorical Perception of Phonemes, Phoneme Awareness, and Visual Attention Span in Developmental Dyslexia

We tested the hypothesis that the categorical perception deficit of speech sounds in developmental dyslexia is related to phoneme awareness skills, whereas a visual attention (VA) span deficit constitutes an independent deficit. Phoneme awareness tasks, VA span tasks and categorical perception tasks of phoneme identification and discrimination using a d/t voicing continuum were administered to 63 dyslexic children and 63 control children matched on chronological age. Results showed significant differences in categorical perception between the dyslexic and control children. Significant correlations were found between categorical perception skills, phoneme awareness and reading. Although VA span correlated with reading, no significant correlations were found between either categorical perception or phoneme awareness and VA span. Mediation analyses performed on the whole dyslexic sample suggested that the effect of categorical perception on reading might be mediated by phoneme awareness. This relationship was independent of the participants’ VA span abilities. Two groups of dyslexic children with a single phoneme awareness or a single VA span deficit were then identified. The phonologically impaired group showed lower categorical perception skills than the control group but categorical perception was similar in the VA span impaired dyslexic and control children. The overall findings suggest that the link between categorical perception, phoneme awareness and reading is independent from VA span skills. These findings provide new insights on the heterogeneity of developmental dyslexia. They suggest that phonological processes and VA span independently affect reading acquisition.

Modulating Human Auditory Processing by Transcranial Electrical Stimulation

Transcranial electrical stimulation (tES) has become a valuable research tool for the investigation of neurophysiological processes underlying human action and cognition. In recent years, striking evidence for the neuromodulatory effects of transcranial direct current stimulation, transcranial alternating current stimulation, and transcranial random noise stimulation has emerged. While the wealth of knowledge has been gained about tES in the motor domain and, to a lesser extent, about its ability to modulate human cognition, surprisingly little is known about its impact on perceptual processing, particularly in the auditory domain. Moreover, while only a few studies systematically investigated the impact of auditory tES, it has already been applied in a large number of clinical trials, leading to a remarkable imbalance between basic and clinical research on auditory tES. Here, we review the state of the art of tES application in the auditory domain focussing on the impact of neuromodulation on acoustic perception and its potential for clinical application in the treatment of auditory related disorders.

Changed categorical perception of consonant-vowel syllables induced by transcranial direct current stimulation (tDCS)

Background

Speech-related disorders may refer to impairment of temporal analysis in the human auditory system. By the advance of non-invasive brain stimulation new forms of therapy arise. In the present study, we examined the neuromodulatory effect of auditory tDCS on the perception of temporal modulated speech syllables. In three experimental sessions we assessed phonetic categorization of consonant–vowels (CV)-syllables (/da/,/ta/) with varying voice onset times (VOT) during sham, anodal, and cathodal tDCS delivered bilateral to the auditory cortex (AC). Subsequently, we recorded auditory evoked potentials (AEP) in response to voiced (/ba/,/da/,/ga/) and voiceless (/pa/,/ta/,/ka/) CV-syllables.

Results

In result, we demonstrate that bilateral tDCS of the AC can modulate CV-syllable perception. Behaviorally, cathodal tDCS improved phonetic categorization abilities in a VOT continuum accompanied by an elevation of the P50 amplitude of the AEP to CV-syllables during the anodal tDCS after effect.

Conclusions

The present study demonstrates the ability of bilateral tDCS over the AC to ameliorate speech perception. The results may have clinical implications by fostering potential approaches for a treatment of speech-related pathologies with a deficit of temporal processing.

Improving reading skills in students with dyslexia: the efficacy of a sublexical training with rhythmic background

The core deficit underlying developmental dyslexia (DD) has been identified in difficulties in dynamic and rapidly changing auditory information processing, which contribute to the development of impaired phonological representations for words. It has been argued that enhancing basic musical rhythm perception skills in children with DD may have a positive effect on reading abilities because music and language share common mechanisms and thus transfer effects from the former to the latter are expected to occur. A computer-assisted training, called Rhythmic Reading Training (RRT), was designed in which reading exercises are combined with rhythm background. Fourteen junior high school students with DD took part to 9 biweekly individual sessions of 30 min in which RRT was implemented. Reading improvements after the intervention period were compared with ones of a matched control group of 14 students with DD who received no intervention. Results indicated that RRT had a positive effect on both reading speed and accuracy and significant effects were found on short pseudo-words reading speed, long pseudo-words reading speed, high frequency long words reading accuracy, and text reading accuracy. No difference in rhythm perception between the intervention and control group were found. Findings suggest that rhythm facilitates the development of reading skill because of the temporal structure it imposes to word decoding.

Music and Sound in Time Processing of Children with ADHD

ADHD involves cognitive and behavioral aspects with impairments in many environments of children and their families' lives. Music, with its playful, spontaneous, affective, motivational, temporal, and rhythmic dimensions can be of great help for studying the aspects of time processing in ADHD. In this article, we studied time processing with simple sounds and music in children with ADHD with the hypothesis that children with ADHD have a different performance when compared with children with normal development in tasks of time estimation and production. The main objective was to develop sound and musical tasks to evaluate and correlate the performance of children with ADHD, with and without methylphenidate, compared to a control group with typical development. The study involved 36 participants of age 6-14 years, recruited at NANI-UNIFESP/SP, subdivided into three groups with 12 children in each. Data was collected through a musical keyboard using Logic Audio Software 9.0 on the computer that recorded the participant's performance in the tasks. Tasks were divided into sections: spontaneous time production, time estimation with simple sounds, and time estimation with music.

RESULTS

(1) performance of ADHD groups in temporal estimation of simple sounds in short time intervals (30 ms) were statistically lower than that of control group (p < 0.05); (2) in the task comparing musical excerpts of the same duration (7 s), ADHD groups considered the tracks longer when the musical notes had longer durations, while in the control group, the duration was related to the density of musical notes in the track. The positive average performance observed in the three groups in most tasks perhaps indicates the possibility that music can, in some way, positively modulate the symptoms of inattention in ADHD.

Objective measurement of high-level auditory cortical function in children

OBJECTIVE

This study examined whether the N2 latency of the cortical auditory evoked potential (CAEP) could be used as an objective indicator of temporal processing ability in normally hearing children.

METHODS

The N2 latency was evoked using three temporal processing paradigms: (1) differences in voice-onset-times (VOTs); (2) speech-in-noise using the CV/da/embedded in broadband noise (BBN) with varying signal-to-noise ratios (SNRs); and (3) 16Hz amplitude-modulated (AM) BBN presented (i) alone and (ii) following an unmodulated BBN, using four modulation depths. Thirty-four school-aged children with normal hearing, speech, language and reading were stratified into two groups: 5-7 years (n=13) and 8-12 years (n=21).

RESULTS

The N2 latency shifted significantly and systematically with differences in VOT and SNR, and was significantly different in the two AM-BBN conditions.

CONCLUSIONS

For children without an N1 peak in the cortical waveform, the N2 peak can be used as a sensitive measure of temporal processing for these stimuli.

SIGNIFICANCE

N2 latency of the CAEP can be used as an objective measure of temporal processing ability in a paediatric population with temporal processing disorder who are difficult to assess via behavioural response.

The Music Perception Performance of Children with and without Dyslexia in Taiwan

Some Western studies have suggested a strong relation between musical discrimination abilities and reading-related skills. Music processing abilities and reading-related skills were evaluated for typically developing children and children with dyslexia. The results showed that pitch discrimination abilities of Chinese dyslexic children are not different from those of typically developing children. However, the former have poorer rhythm imitation abilities. Thus, in Chinese reading there is a strong relation between rhythm and reading acquisition, which is consistent with the research results on alphabetic languages. On the other hand, a significant correlation existed between the rhythm imitation ability and performance on the onset deletion test for all participants, which suggested that there was a close relation between the function of organizing the distinctive features in appropriate rhythmic pattern and the segmental phonological processing deficits of dyslexic children.

Effect of 24 hours of sleep deprivation on auditory and linguistic perception: a comparison among young controls, sleep-deprived participants, dyslexic readers, and aging adults

PURPOSE

To test the effects of 24 hr of sleep deprivation on auditory and linguistic perception and to assess the magnitude of this effect by comparing such performance with that of aging adults on speech perception and with that of dyslexic readers on phonological awareness.

METHOD

Fifty-five sleep-deprived young adults were compared with 29 aging adults (older than 60 years) and with 18 young controls on auditory temporal order judgment (TOJ) and on speech perception tasks (Experiment 1). The sleep deprived were also compared with 51 dyslexic readers and with the young controls on TOJ and phonological awareness tasks (One-Minute Test for Pseudowords, Phoneme Deletion, Pig Latin, and Spoonerism; Experiment 2).

RESULTS

Sleep deprivation resulted in longer TOJ thresholds, poorer speech perception, and poorer nonword reading compared with controls. The TOJ thresholds of the sleep deprived were comparable to those of the aging adults, but their pattern of speech performance differed. They also performed better on TOJ and phonological awareness than dyslexic readers.

CONCLUSIONS

A variety of linguistic skills are affected by sleep deprivation. The comparison of sleep-deprived individuals with other groups with known difficulties in these linguistic skills might suggest that different groups exhibit common difficulties.

Reading into neuronal oscillations in the visual system: implications for developmental dyslexia

While phonological impairments are common in developmental dyslexia, there has recently been much debate as to whether there is a causal link between the phonological difficulties and the reading problem. An alternative suggestion has been gaining ground that the core deficit in dyslexia is in visual attentional mechanisms. If so, the visual aetiology may be at any of a number of sites along the afferent magnocellular pathway or in the dorsal cortical stream that are all essential for a visuo-spatial attentional feedback to the primary visual cortex. It has been suggested that the same circuits and pathways of top-down attention used for serial visual search are used for reading. Top-down signals from the dorsal parietal areas to primary visual cortex serially highlight cortical locations representing successive letters in a text before they can be recognized and concatenated into a word. We had shown in non-human primates that the mechanism of such a top-down feedback in a visual attention task uses synchronized neuronal oscillations at the lower end of the gamma frequency range. It is no coincidence that reading graphemes in a text also happens at the low gamma frequencies. The basic proposal here is that each cycle of gamma oscillation focuses an attentional spotlight on the primary visual cortical representation of just one or two letters before sequential recognition of letters and their concatenation into word strings. The timing, period, envelope, amplitude, and phase of the synchronized oscillations modulating the incoming signals in the striate cortex would have a profound influence on the accuracy and speed of reading. Thus, the general temporal sampling difficulties in dyslexic subjects may impact reading not necessarily by causing phonological deficits, but by affecting the spatio-temporal parsing of the visual input within the visual system before these signals are used for letter and word recognition.

Speech perception in noise by children with cochlear implants

PURPOSE

Common wisdom suggests that listening in noise poses disproportionately greater difficulty for listeners with cochlear implants (CIs) than for peers with normal hearing (NH). The purpose of this study was to examine phonological, language, and cognitive skills that might help explain speech-in-noise abilities for children with CIs.

METHOD

Three groups of kindergartners (NH, hearing aid wearers, and CI users) were tested on speech recognition in quiet and noise and on tasks thought to underlie the abilities that fit into the domains of phonological awareness, general language, and cognitive skills. These last measures were used as predictor variables in regression analyses with speech-in-noise scores as dependent variables.

RESULTS

Compared to children with NH, children with CIs did not perform as well on speech recognition in noise or on most other measures, including recognition in quiet. Two surprising results were that (a) noise effects were consistent across groups and (b) scores on other measures did not explain any group differences in speech recognition.

CONCLUSIONS

Limitations of implant processing take their primary toll on recognition in quiet and account for poor speech recognition and language/phonological deficits in children with CIs. Implications are that teachers/clinicians need to teach language/phonology directly and maximize signal-to-noise levels in the classroom.

Gaps-in-noise (GIN©) test results in children with and without reading disabilities and phonological processing deficits

OBJECTIVE

To determine if the gaps-in-noise (GIN(©)) test could differentiate children with dyslexia and significant phonological awareness deficits from a group of children with normal reading skills.

DESIGN

A prospective study of GIN test performance in two groups of children. Participants were administered routine audiological tests, a phonological processing test, and an auditory temporal resolution test (GIN test). Statistical testing was completed to determine if significant differences existed between groups on GIN test results and phonological processing measures, and to examine potential relationships between these test measures. Routine clinical analysis procedures examined the performance of the two groups from a clinical perspective.

STUDY SAMPLE

Participants included 61 children between the ages of 8 years, 1 month and 9 years, 11 months, separated into two groups: children with dyslexia and significant phonological deficits (Group I); normal-reading peers with age-appropriate phonological skills (Group II).

RESULTS

Children in Group I showed longer gap detection (GD) thresholds and lower gap identification scores than did the children in Group II. Results of statistical and clinical testing revealed significant differences between the groups.

CONCLUSION

An auditory temporal processing deficit is a factor to be considered in children presenting with dyslexia and phonological processing disorders.

Perception of stop onset spectra in Chinese children with phonological dyslexia

The ability to identify stop consonants from brief onset spectra was compared between a group of Chinese children with phonological dyslexia (the PD group, with a mean age of 10 years 4 months) and a group of chronological age-matched control children. The linguistic context, which included vowels and speakers, and durations of stop onset spectra were varied. Children with PD showed lower identification accuracy and exhibited a smaller vowel context effect for some stop-vowel combinations compared with the chronological age-matched control group. Further analyses revealed that the PD group had more variable response patterns, and their responses were less consistent with the acoustic characteristics of stop onset spectra. The results suggest that Chinese children with PD do not show greater sensitivity to allophonic acoustic variability compared with control children and exhibit a generally less robust response pattern to phonetic categories.

Reduced Sensory Oscillatory Activity during Rapid Auditory Processing as a Correlate of Language-Learning Impairment

Successful language acquisition has been hypothesized to involve the ability to integrate rapidly presented, brief acoustic cues in sensory cortex. A body of work has suggested that this ability is compromised in language-learning impairment (LLI). The present research aimed to examine sensory integration during rapid auditory processing by means of electrophysiological measures of oscillatory brain activity using data from a larger longitudinal study. Twenty-nine children with LLI and control participants with typical language development (n=18) listened to tone doublets presented at a temporal interval that is essential for accurate speech processing (70-ms interstimulus interval). The children performed a deviant (pitch change of second tone) detection task, or listened passively. The electroencephalogram was recorded from 64 electrodes. Data were source-projected to the auditory cortices and submitted to wavelet analysis, resulting in time-frequency representations of electrocortical activity. Results show significantly reduced amplitude and phase-locking of early (45-75 ms) oscillations in the gamma-band range (29-52 Hz), specifically in the LLI group, for the second stimulus of the tone doublet. This suggests altered temporal organization of sensory oscillatory activity in LLI when processing rapid sequences.

Impairments in speech and nonspeech sound categorization in children with dyslexia are driven by temporal processing difficulties

Auditory processing problems in persons with dyslexia are still subject to debate, and one central issue concerns the specific nature of the deficit. In particular, it is questioned whether the deficit is specific to speech and/or specific to temporal processing. To resolve this issue, a categorical perception identification task was administered in thirteen 11-year old dyslexic readers and 25 matched normal readers using 4 sound continua: (1) a speech contrast exploiting temporal cues (/bA/-/dA/), (2) a speech contrast defined by nontemporal spectral cues (/u/-/y/), (3) a nonspeech temporal contrast (spectrally rotated/bA/-/da/), and (4) a nonspeech nontemporal contrast (spectrally rotated/u/-/y/). Results indicate that children with dyslexia are less consistent in classifying speech and nonspeech sounds on the basis of rapidly changing (i.e., temporal) information whereas they are unimpaired in steady-state speech and nonspeech sounds. The deficit is thus restricted to categorizing sounds on the basis of temporal cues and is independent of the speech status of the stimuli. The finding of a temporal-specific but not speech-specific deficit in children with dyslexia is in line with findings obtained in adults using the same paradigm (Vandermosten et al., 2010, Proceedings of the National Academy of Sciences of the United States of America, 107: 10389-10394). Comparison of the child and adult data indicates that the consistency of categorization considerably improves between late childhood and adulthood, particularly for the continua with temporal cues. Dyslexic and normal readers show a similar developmental progress with the dyslexic readers lagging behind both in late childhood and in adulthood.

The nature of the phonological processing in French dyslexic children: evidence for the phonological syllable and linguistic features' role in silent reading and speech discrimination

This study investigated the status of phonological representations in French dyslexic children (DY) compared with reading level- (RL) and chronological age-matched (CA) controls. We focused on the syllable's role and on the impact of French linguistic features. In Experiment 1, we assessed oral discrimination abilities of pairs of syllables that varied as a function of voicing, mode or place of articulation, or syllable structure. Results suggest that DY children underperform controls with a 'speed-accuracy' deficit. However, DY children exhibit some similar processing than those highlighted in controls. As in CA and RL controls, DY children have difficulties in processing two sounds that only differ in voicing, and preferentially process obstruent rather than fricative sounds, and more efficiently process CV than CCV syllables. In Experiment 2, we used a modified version of the Colé, Magnan, and Grainger's (Applied Psycholinguistics 20:507-532, 1999) paradigm. Results show that DY children underperform CA controls but outperform RL controls. However, as in CA and RL controls, data reveal that DY children are able to use phonological procedures influenced by initial syllable frequency. Thus, DY children process syllabically high-frequency syllables but phonemically process low-frequency syllables. They also exhibit lexical and syllable frequency effects. Consequently, results provide evidence that DY children performances can be accounted for by laborious phonological syllable-based procedures and also degraded phonological representations.

Decreased sensitivity to phonemic mismatch in spoken word processing in adult developmental dyslexia

Initial lexical activation in typical populations is a direct reflection of the goodness of fit between the presented stimulus and the intended target. In this study, lexical activation was investigated upon presentation of polysyllabic pseudowords (such as procodile for crocodile) for the atypical population of dyslexic adults to see to what extent mismatching phonemic information affects lexical activation in the face of overwhelming support for one specific lexical candidate. Results of an auditory lexical decision task showed that sensitivity to phonemic mismatch was less in the dyslexic population, compared to the respective control group. However, the dyslexic participants were outperformed by their controls only for word-initial mismatches. It is argued that a subtle speech decoding deficit affects lexical activation levels and makes spoken word processing less robust against distortion.

Adults with dyslexia are impaired in categorizing speech and nonspeech sounds on the basis of temporal cues

Developmental dyslexia is characterized by severe reading and spelling difficulties that are persistent and resistant to the usual didactic measures and remedial efforts. It is well established that a major cause of these problems lies in poorly specified representations of speech sounds. One hypothesis states that this phonological deficit results from a more fundamental deficit in auditory processing. Despite substantial research effort, the specific nature of these auditory problems remains debated. A first controversy concerns the speech specificity of the auditory processing problems: Can they be reduced to more basic auditory processing, or are they specific to the perception of speech sounds? A second topic of debate concerns the extent to which the auditory problems are specific to the processing of rapidly changing temporal information or whether they encompass a broader range of complex spectro-temporal processing. By applying a balanced design with stimuli that were adequately controlled for acoustic complexity, we show that adults with dyslexia are specifically impaired at categorizing speech and nonspeech sounds that differ in terms of rapidly changing acoustic cues (i.e., temporal cues), but that they perform adequately when categorizing steady-state speech and nonspeech sounds. Thus, we show that individuals with dyslexia have an auditory temporal processing deficit that is not speech-specific.

Speech perception abilities of adults with dyslexia: is there any evidence for a true deficit?

PURPOSE

This study investigated whether adults with dyslexia show evidence of a consistent speech perception deficit by testing phoneme categorization and word perception in noise.

METHOD

Seventeen adults with dyslexia and 20 average readers underwent a test battery including standardized reading, language and phonological awareness tests, and tests of speech perception. Categorization of a pea/bee voicing contrast was evaluated using adaptive identification and discrimination tasks, presented in quiet and in noise, and a fixed-step discrimination task. Two further tests of word perception in noise were presented.

RESULTS

There were no significant group differences for categorization in quiet or noise, across- and within-category discrimination as measured adaptively, or word perception, but average readers showed better across- and within-category discrimination in the fixed-step discrimination task. Individuals did not show consistent poor performance across related tasks.

CONCLUSIONS

The small number of group differences, and lack of consistent poor individual performance, suggests weak support for a speech perception deficit in dyslexia. It seems likely that at least some poor performances are attributable to nonsensory factors like attention. It may also be that some individuals with dyslexia have speech perceptual acuity that is at the lower end of the normal range and exacerbated by nonsensory factors.

Electrical brain imaging evidences left auditory cortex involvement in speech and non-speech discrimination based on temporal features

BACKGROUND

Speech perception is based on a variety of spectral and temporal acoustic features available in the acoustic signal. Voice-onset time (VOT) is considered an important cue that is cardinal for phonetic perception.

METHODS

In the present study, we recorded and compared scalp auditory evoked potentials (AEP) in response to consonant-vowel-syllables (CV) with varying voice-onset-times (VOT) and non-speech analogues with varying noise-onset-time (NOT). In particular, we aimed to investigate the spatio-temporal pattern of acoustic feature processing underlying elemental speech perception and relate this temporal processing mechanism to specific activations of the auditory cortex.

RESULTS

Results show that the characteristic AEP waveform in response to consonant-vowel-syllables is on a par with those of non-speech sounds with analogue temporal characteristics. The amplitude of the N1a and N1b component of the auditory evoked potentials significantly correlated with the duration of the VOT in CV and likewise, with the duration of the NOT in non-speech sounds.Furthermore, current density maps indicate overlapping supratemporal networks involved in the perception of both speech and non-speech sounds with a bilateral activation pattern during the N1a time window and leftward asymmetry during the N1b time window. Elaborate regional statistical analysis of the activation over the middle and posterior portion of the supratemporal plane (STP) revealed strong left lateralized responses over the middle STP for both the N1a and N1b component, and a functional leftward asymmetry over the posterior STP for the N1b component.

CONCLUSION

The present data demonstrate overlapping spatio-temporal brain responses during the perception of temporal acoustic cues in both speech and non-speech sounds. Source estimation evidences a preponderant role of the left middle and posterior auditory cortex in speech and non-speech discrimination based on temporal features. Therefore, in congruency with recent fMRI studies, we suggest that similar mechanisms underlie the perception of linguistically different but acoustically equivalent auditory events on the level of basic auditory analysis.

Linear coding of voice onset time

Voice onset time (VOT) provides an important auditory cue for recognizing spoken consonant-vowel syllables. Although changes in the neuromagnetic response to consonant-vowel syllables with different VOT have been examined, such experiments have only manipulated VOT with respect to voicing. We utilized the characteristics of a previously developed asymmetric VOT continuum [Liederman, J., Frye, R. E., McGraw Fisher, J., Greenwood, K., & Alexander, R. A temporally dynamic contextual effect that disrupts voice onset time discrimination of rapidly successive stimuli. Psychonomic Bulletin and Review, 12, 380-386, 2005] to determine if changes in the prominent M100 neuromagnetic response were linearly modulated by VOT. Eight right-handed, English-speaking, normally developing participants performed a VOT discrimination task during a whole-head neuromagnetic recording. The M100 was identified in the gradiometers overlying the right and left temporal cortices and single dipoles were fit to each M100 waveform. A repeated measures analysis of variance with post hoc contrast test for linear trend was used to determine whether characteristics of the M100 were linearly modulated by VOT. The morphology of the M100 gradiometer waveform and the peak latency of the dipole waveform were linearly modulated by VOT. This modulation was much greater in the left, as compared to the right, hemisphere. The M100 dipole moved in a linear fashion as VOT increased in both hemispheres, but along different axes in each hemisphere. This study suggests that VOT may linearly modulate characteristics of the M100, predominately in the left hemisphere, and suggests that the VOT of consonant-vowel syllables, instead of, or in addition to, voicing, should be examined in future experiments.

Mismatch negativity in children with dyslexia speaking Indian languages

BACKGROUND

Several studies in the past have found that phonological processing is abnormal in children with dyslexia. Phonological processing depends on the phonological rules of the language learnt. Western languages do not have a good phoneme to grapheme correspondence while many of the Indian languages do have it. Also phonological rules of western languages are different from that of Indian languages. Thus it would be erroneous to generalize the results of phonological processing obtained on children speaking western languages to those speaking Indian languages. Hence the present study was aimed to investigate the auditory processing in children with dyslexia who spoke and studied Indian languages.

METHODS

Standard group comparison design was used in the study. The study was conducted on fifteen children with dyslexia and fifteen control children. Mismatch negativity was elicited for speech and tonal stimuli. Results obtained on the clinical group were compared with that of control group using mixed design Analysis of variance. Children in both the groups were native speakers of Kannada (a south Indian language).

RESULTS

A subgroup of children showed abnormalities in the processing of speech and/or tonal stimuli. Speech elicited mismatch negativity showed greater abnormalities than that of tonal stimuli. Though higher for spectral contrasts, processing deficits were also shown for durational contrasts.

CONCLUSION

Inspite of having different phonological rules and good phoneme-grapheme correspondence in Indian languages, children with dyslexia do have deficits in processing both spectral and durational cues.

Effects of phonological contrast on auditory word discrimination in children with and without reading disability: a magnetoencephalography (MEG) study

Poor readers perform worse than their normal reading peers on a variety of speech perception tasks, which may be linked to their phonological processing abilities. The purpose of the study was to compare the brain activation patterns of normal and impaired readers on speech perception to better understand the phonological basis in reading disability. Whole-head magnetoencephalography (MEG) was recorded as good and poor readers, 7-13 years of age, performed an auditory word discrimination task. We used an auditory oddball paradigm in which the 'deviant' stimuli (/bat/, /kat/, /rat/) differed in the degree of phonological contrast (one versus three features) from a repeated standard word (/pat/). Both good and poor readers responded more slowly to deviants that were phonologically similar compared to deviants that were phonologically dissimilar to the standard word. Source analysis of the MEG data using minimum norm estimation (MNE) showed that compared to good readers, poor readers had reduced left-hemisphere activation to the most demanding phonological condition reflecting their difficulties with phonological processing. Furthermore, unlike good readers, poor readers did not show differences in activation as a function of the degree of phonological contrast. These results are consistent with a phonological account of reading disability.

Locus and nature of perceptual phonological deficit in Spanish children with reading disabilities

The aims of this study were (a) to determine whether Spanish children with reading disabilities (RD) show a speech perception deficit and (b) to explore the locus and nature of this perceptive deficit. A group of 29 children with RD, 41 chronological age-matched controls, and 27 reading ability-matched younger controls were tested on tasks of speech perception. The effect of linguistic unit (word vs. syllable) and type of phonetic contrast (voicing, place and manner of articulation) were analyzed in terms of the number of errors and the response time. The results revealed a speech perception deficit in Spanish children with RD that was independent of the type of phonetic contrast and of linguistic unit.

Effect of attentional state on frequency discrimination: a comparison of children with ADHD on and off medication

Debate continues over the hypothesis that children with language or literacy difficulties have a genuine auditory processing deficit. Several recent studies have reported deficits in frequency discrimination (FD), but it is unclear whether these are genuine perceptual impairments or reflective of the comorbid attentional problems that exist in many children with language and literacy difficulties. The present study investigated FD in children with attention deficit hyperactivity disorder (ADHD) when their attentional state was altered with stimulant medication. Auditory thresholds were obtained using FD and frequency modulation detection (FM) tasks. In the FD task, participants judged which of 2 pairs contained a high-low frequency sound, and in the FM task, children judged which of two tones "wobbled" (i.e., modulated). Children with ADHD had significantly poorer and more variable FD performance when off compared to on stimulant medication, and did significantly worse than controls on all FD runs when off but not on stimulant medication. However, children with ADHD did not differ from controls on the FM task. These findings demonstrate that certain auditory discrimination tasks are influenced by the child's attentional status. In addition, significant relationships between FD and measures of language and reading were abolished when comorbid attentional difficulties were taken into account. The study has implications for design and interpretation of studies investigating links between auditory discrimination and difficulties in language and literacy.

Dynamic auditory processing, musical experience and language development

Children with language-learning impairments (LLI) form a heterogeneous population with the majority having both spoken and written language deficits as well as sensorimotor deficits, specifically those related to dynamic processing. Research has focused on whether or not sensorimotor deficits, specifically auditory spectrotemporal processing deficits, cause phonological deficit, leading to language and reading impairments. New trends aimed at resolving this question include prospective longitudinal studies of genetically at-risk infants, electrophysiological and neuroimaging studies, and studies aimed at evaluating the effects of auditory training (including musical training) on brain organization for language. Better understanding of the origins of developmental LLI will advance our understanding of the neurobiological mechanisms underlying individual differences in language development and lead to more effective educational and intervention strategies. This review is part of the INMED/TINS special issue "Nature and nurture in brain development and neurological disorders", based on presentations at the annual INMED/TINS symposium (http://inmednet.com/).

Temporal processing deficits in Hebrew speaking children with reading disabilities

The purpose of this study was to assess to what extent specific reading disabilities and poor phonologic processing in children who read Hebrew, a primarily consonant orthography, are related to central auditory temporal processing deficits (TPDs).Twenty-four Hebrew-speaking children (ages 10-13) with and without reading disabilities were asked to discriminate auditorily pairs of syllables (/ba/ vs. /pa/) that differ by voice onset time (VOT) only. Two paradigms were used, 1 with a short interstimulus interval (ISI) (50 ms) and 1 with a long ISI (500 ms). Event-related potentials (ERPs) were measured in response to the two syllables in an auditory oddball task. Results showed significantly lowered accuracy, longer reaction times, and prolonged P3 latency among the group with reading disabilities compared with the control group. No significant differences were found between the short ISI task and the long ISI task. However, significant correlations were found between the phonologic processing tasks and the short ISI task. These findings in the Hebrew language are consistent with findings from other languages and add support to the central TPD hypothesis of reading disabilities. The discussion highlights how investigating different orthographic systems can deepen our understanding of the role TPD plays in reading.

Early experience of sex hormones as a predictor of reading, phonology, and auditory perception

Previous research has indicated possible reciprocal connections between phonology and reading, and also connections between aspects of auditory perception and reading. The present study investigates these associations further by examining the potential influence of prenatal androgens using measures of digit ratio (the ratio of the lengths of the index and ring fingers). Those with low digit ratios (shorter index finger and therefore in the masculine direction) are hypothesised to have experienced greater "masculinisation" in the uterus. ANCOVA analyses using a verbal reasoning task as a covariate showed that only phonology was influenced by digit ratio in the right hand indicating that hypothesised androgen effects were inhibiting phonology; however this effect in the left hand was reduced and instead there was an effect indicating an inhibition of androgens on reading. Furthermore, subjects with low right-hand digit ratios were also impaired compared to those with high right-hand digit ratios in an auditory saltation task. These findings are discussed in terms of the possible effects of androgens on early brain development impairing aspects of the temporal processing of sounds by the left hemisphere, which could also have a secondary influence on developing phonology and literacy skills.

A temporally dynamic context effect that disrupts voice onset time discrimination of rapidly successive stimuli

Across three experiments, voice onset time discrimination along a/ba/-/pa/ continuum was found to be influenced by the order of presentation of rapidly successive stimuli. Specifically, discrimination was disrupted when a relatively unambiguous /pa/ syllable was presented before, rather than after, a more ambiguous /pa/ or/ba/ syllable. In Experiments 1 and 2, for between-category discrimination, this order effect was significant at interstimulus intervals (ISIs) below 250 msec, but not at 250 or 1,000 msec. In Experiments 2 and 3, the order effect was also significant for within-category discrimination at ISIs below 250 msec. In addition, in Experiment 3 this order effect was not diminished by provision of performance feedback across eight testing sessions. These findings reveal a particular vulnerability of phonological processing in response to rapidly successive stimuli and may have implications for mathematical and neural models of speech processing of normal and impaired populations.