Reading improvement in English- and Hebrew-speaking children with reading difficulties after reading acceleration training

Executive functions-based reading training engages the cingulo-opercular and dorsal attention networks

The aim of this study was to determine the effect of a computerized executive functions (EFs)-based reading intervention on neural circuits supporting EFs and visual attention. Seed-to-voxel functional connectivity analysis was conducted focusing on large-scale attention system brain networks, during an fMRI reading fluency task. Participants were 8- to 12-year-old English-speaking children with dyslexia (n = 43) and typical readers (n = 36) trained on an EFs-based reading training (n = 40) versus math training (n = 39). Training duration was 8 weeks. After the EFs-based reading intervention, children with dyslexia improved their scores in reading rate and visual attention (compared to math intervention). Neurobiologically, children with dyslexia displayed an increase in functional connectivity strength after the intervention between the cingulo-opercular network and occipital and precentral regions. Noteworthy, the functional connectivity indices between these brain regions showed a positive correlation with speed of processing and visual attention scores in both pretest and posttest. The results suggest that reading improvement following an EFs-based reading intervention involves neuroplastic connectivity changes in brain areas related to EFs and primary visual processing in children with dyslexia. Our results highlight the need for training underlying cognitive abilities supporting reading, such as EFs and visual attention, in order to enhance reading abilities in dyslexia.

Fluent contextual reading is associated with greater synchronization of the visual and auditory networks, fluent reading and better speed of processing in children with dyslexia

The asynchrony theory of dyslexia postulates weaker visual (orthographical processing) and auditory (phonological processing) network synchrony in dyslexic readers. The weaker visual-auditory network synchronization is suggested to contribute to slow processing speed, which supports cognitive control, contributing to single-word reading difficulty and lower reading fluency. The current study aims to determine the neurobiological signature for this theory and to examine if prompting enhanced reading speed through deleted text is associated with a greater synchronization of functional connectivity of the visual and auditory networks in children with dyslexia and typical readers (TRs). We further aimed to determine if the change in visual-auditory connectivity prompted by deleted text is associated with reading fluency and processing speed abilities. Nineteen children with dyslexia and 21 typical readers ages 8-12 years old participated in a fMRI under two types of reading conditions: a still text condition and deleted text condition, in which letters was sequentially deleted from the screen. Effects of diagnostic group and condition on functional connectivity (FC) of visual and auditory networks were examined. Results revealed a significant overall effect of condition with a marginally significant Group × Condition interaction, such that as compared with TRs, children with dyslexia showed a significantly greater increase in visual-auditory FC between the still and deleted text conditions. Additionally, for children with dyslexia, this FC increase was significantly correlated with better reading fluency and verbal/nonverbal processing speed. These results support a relationship between the synchronization of the visual and auditory networks, fluent reading and increased speed of processing abilities in children with dyslexia, which can help guide fluency-based intervention strategies.

The role of visual attention in dyslexia: Behavioral and neurobiological evidence

Poor phonological processing has typically been considered the main cause of dyslexia. However, visuo‐attentional processing abnormalities have been described as well. The goal of the present study was to determine the involvement of visual attention during fluent reading in children with dyslexia and typical readers. Here, 75 children (8–12 years old; 36 typical readers, 39 children with dyslexia) completed cognitive and reading assessments. Neuroimaging data were acquired while children performed a fluent reading task with (a) a condition where the text remained on the screen (Still) versus (b) a condition in which the letters were being deleted (Deleted). Cognitive assessment data analysis revealed that visual attention, executive functions, and phonological awareness significantly contributed to reading comprehension in both groups. A seed‐to‐voxel functional connectivity analysis was performed on the fluency functional magnetic resonance imaging task. Typical readers showed greater functional connectivity between the dorsal attention network and the left angular gyrus while performing the Still and Deleted reading tasks versus children with dyslexia. Higher connectivity values were associated with higher reading comprehension. The control group showed increased functional connectivity between the ventral attention network and the fronto‐parietal network during the Deleted text condition (compared with the Still condition). Children with dyslexia did not display this pattern. The results suggest that the synchronized activity of executive, visual attention, and reading‐related networks is a pattern of functional integration which children with dyslexia fail to achieve. The present evidence points toward a critical role of visual attention in dyslexia.

Gray matter correlates of reading fluency deficits: SES matters, IQ does not

Brain correlates of reading ability have been intensely investigated. Most studies have focused on single-word reading and phonological processing, but the brain basis of reading fluency remains poorly explored to date. Here, in a voxel-based morphometry study with 8-year-old children, we compared fluent readers (n = 18; seven boys) with dysfluent readers with normal IQ (n = 18; six boys) and with low IQ (n = 18; ten boys). Relative to dysfluent readers, fluent readers had larger gray matter volume in the right superior temporal gyrus and the two subgroups of dysfluent readers did not differ from each other, as shown in frequentist and Bayesian analyses. Pairwise comparisons showed that dysfluent readers of normal and low IQ did not differ in core reading regions and that both subgroups had less gray matter volume than fluent readers in occipito-temporal, parieto-temporal and fusiform areas. We also examined gray matter volume in matched subgroups of dysfluent readers differing only in socioeconomic status (SES): lower-SES (n = 14; seven boys) vs. higher-SES (n = 14; seven boys). Higher-SES dysfluent readers had larger gray matter volume in the right angular gyrus than their lower-SES peers, and the volume of this cluster correlated positively with lexico-semantic fluency. Age, sex, IQ, and gray matter volume of the right angular cluster explained 68% of the variance in the reading fluency of higher-SES dysfluent readers. In sum, this study shows that gray matter correlates of dysfluent reading are independent of IQ, and suggests that SES modulates areas sub-serving lexico-semantic processes in dysfluent readers-two findings that may be useful to inform language/reading remediation programs.

Dyslexia treatment studies: A systematic review and suggestions on testing treatment efficacy with small effects and small samples

Poor response to treatment is a defining characteristic of reading disorder. In the present systematic review and meta-analysis, we found that the overall average effect size for treatment efficacy was modest, with a mean standardized difference of 0.38. Small true effects, combined with the difficulty to recruit large samples, seriously challenge researchers planning to test treatment efficacy in dyslexia and potentially in other learning disorders. Nonetheless, most published studies claim effectiveness, generally based on liberal use of multiple testing. This inflates the risk that most statistically significant results are associated with overestimated effect sizes. To enhance power, we propose the strategic use of repeated measurements with mixed-effects modelling. This novel approach would enable us to estimate both individual parameters and population-level effects more reliably. We suggest assessing a reading outcome not once, but three times, at pre-treatment and three times at post-treatment. Such design would require only modest additional efforts compared to current practices. Based on this, we performed ad hoc a priori design analyses via simulation studies. Results showed that using the novel design may allow one to reach adequate power even with low sample sizes of 30–40 participants (i.e., 15–20 participants per group) for a typical effect size of d = 0.38. Nonetheless, more conservative assumptions are warranted for various reasons, including a high risk of publication bias in the extant literature. Our considerations can be extended to intervention studies of other types of neurodevelopmental disorders.

Altered association between executive functions and reading and math fluency tasks in children with reading difficulties compared with typical readers

Fluent reading in children relies on executive functions (EF). Recent research suggests that EF skills also affect arithmetic abilities. Children with reading difficulties (RD) experience deficits in EF. It is still unknown to what extent these EF deficits are the basis for both reading and arithmetic skills in children with RD compared with typical readers. To define the role of EF in reading and arithmetic in children with RD and typical readers, EF measures and reading and arithmetic fluency and non-fluency measures were assessed in 8 to 12-year-old children with RD and age-matched typical readers. Comparison and correlation analyses were performed within and between the two groups. Children with RD scored lower on reading and arithmetic fluency and non-fluency tasks compared with typical readers. For both groups, fluency measures were lower than non-fluency measures. Strong correlations were found within the entire study population between fluency measures and EF, as well as between non-fluency measures and EF compared with mixed correlations observed for the groups separately. Fluency was related to subcomponents of EF expressed in both reading and arithmetic domains for the two groups. The role of each domain and comparison with non-fluency results for each group are discussed.

Increased deficit of visual attention span with development in Chinese children with developmental dyslexia

It has been suggested that orthographic transparency and age changes may affect the relationship between visual attention span (VAS) deficit and reading difficulty. The present study explored the developmental trend of VAS in children with developmental dyslexia (DD) in Chinese, a logographic language with a deep orthography. Fifty-seven Chinese children with DD and fifty-four age-matched normal readers participated. The visual 1-back task was adopted to examine VAS. Phonological and morphological awareness tests, and reading tests in single-character and sentence levels were used for reading skill measurements. Results showed that only high graders with dyslexia exhibited lower accuracy than the controls in the VAS task, revealing an increased VAS deficit with development in the dyslexics. Moreover, the developmental trajectory analyses demonstrated that the dyslexics seemed to exhibit an atypical but not delayed pattern in their VAS development as compared to the controls. A correlation analysis indicated that VAS was only associated with morphological awareness for dyslexic readers in high grades. Further regression analysis showed that VAS skills and morphological awareness made separate and significant contributions to single-character reading for high grader with dyslexia. These findings suggested a developmental increasing trend in the relationship between VAS skills and reading (dis)ability in Chinese.

A Special Chinese Reading Acceleration Training Paradigm: To Enhance the Reading Fluency and Comprehension of Chinese Children with Reading Disabilities

According to a number of studies, use of a Reading Acceleration Program as reading intervention training has been demonstrated to improve reading speed and comprehension level effectively in most languages and countries. The objective of the current study was to provide further evidence of the effectiveness of a Reading Acceleration Program for Chinese children with reading disabilities using a distinctive Chinese reading acceleration training paradigm. The reading acceleration training paradigm is divided into a non-accelerated reading paradigm, a Character-accelerated reading paradigm and a Words-accelerated reading paradigm. The results of training Chinese children with reading disabilities indicate that the acceleration reading paradigm applies to children with Chinese-reading disabilities. In addition, compared with other reading acceleration paradigms, Words-accelerated reading training is more effective in helping children with reading disabilities read at a high speed while maintaining superior comprehension levels.

Improvement of the Error-detection Mechanism in Adults with Dyslexia Following Reading Acceleration Training

The error-detection mechanism aids in preventing error repetition during a given task. Electroencephalography demonstrates that error detection involves two event-related potential components: error-related and correct-response negativities (ERN and CRN, respectively). Dyslexia is characterized by slow, inaccurate reading. In particular, individuals with dyslexia have a less active error-detection mechanism during reading than typical readers. In the current study, we examined whether a reading training programme could improve the ability to recognize words automatically (lexical representations) in adults with dyslexia, thereby resulting in more efficient error detection during reading. Behavioural and electrophysiological measures were obtained using a lexical decision task before and after participants trained with the reading acceleration programme. ERN amplitudes were smaller in individuals with dyslexia than in typical readers before training but increased following training, as did behavioural reading scores. Differences between the pre-training and post-training ERN and CRN components were larger in individuals with dyslexia than in typical readers. Also, the error-detection mechanism as represented by the ERN/CRN complex might serve as a biomarker for dyslexia and be used to evaluate the effectiveness of reading intervention programmes. Copyright © 2016 John Wiley & Sons, Ltd.

In search of methods enhancing fluency in reading: An examination of the relations between time constraints and processes of reading in readers of German

The attainment of fluency in reading is a major difficulty for reading-disabled people. Manipulations applied on the presentation of texts, leading to "on-line" effects on reading (i.e., while texts are manipulated), are one direction of examinations in search of methods affecting reading. The imposing of time constraints, by deleting one letter after the other from texts presented on a computer screen, has been established as such a method. In an attempt to further understand its nature, we tested the relations between time constraints and processes of reading: phonological decoding of small orthogrpahic units and the addressing of orthographic representations from the mental lexicon. We also examined whether the type of orthogrpahic unit deleted (lexical, sublexical, or nonlexical unit) has any additional effect. Participants were German fifth graders with (n = 29) or without (n = 34) reading disability. Time constraints enhanced fluency in reading in both groups, and to a similar extent, across conditions. Comprehension was unimpaired. These results place the very principle of time constraints, regardless of the orthographic unit manipulated, as a critical factor affecting fluency in reading. However, phonological decoding explained a significant amount of variance in fluency in reading across all conditions in reading-disabled children, whereas the addressing of orthographic representations was the consistent predictor of fluency in reading in regular readers. These results indicate a qualitative difference in the processes explaining the variance in fluency in reading in regular and reading-disabled readers and suggest that time constraints might not have an effect on the relations between these processes and reading performance.

Increased Resting-State Functional Connectivity in the Cingulo-Opercular Cognitive-Control Network after Intervention in Children with Reading Difficulties

Dyslexia, or reading difficulty, is characterized by slow, inaccurate reading accompanied by executive dysfunction. Reading training using the Reading Acceleration Program improves reading and executive functions in both children with dyslexia and typical readers. This improvement is associated with increased activation in and functional connectivity between the anterior cingulate cortex, part of the cingulo-opercular cognitive-control network, and the fusiform gyrus during a reading task after training. The objective of the current study was to determine whether the training also has an effect on functional connectivity of the cingulo-opercular and fronto-parietal cognitive-control networks during rest in children with dyslexia and typical readers. Fifteen children with reading difficulty and 17 typical readers (8-12 years old) were included in the study. Reading and executive functions behavioral measures and resting-state functional magnetic resonance imaging data were collected before and after reading training. Imaging data were analyzed using a graphical network-modeling tool. Both reading groups had increased reading and executive-functions scores after training, with greater gains among the dyslexia group. Training may have less effect on cognitive control in typical readers and a more direct effect on the visual area, as previously reported. Statistical analysis revealed that compared to typical readers, children with reading difficulty had significantly greater functional connectivity in the cingulo-opercular network after training, which may demonstrate the importance of cognitive control during reading in this population. These results support previous findings of increased error-monitoring activation after reading training in children with dyslexia and confirm greater gains with training in this group.

Increased resting-state functional connectivity of visual- and cognitive-control brain networks after training in children with reading difficulties

The Reading Acceleration Program, a computerized reading-training program, increases activation in neural circuits related to reading. We examined the effect of the training on the functional connectivity between independent components related to visual processing, executive functions, attention, memory, and language during rest after the training. Children 8-12 years old with reading difficulties and typical readers participated in the study. Behavioral testing and functional magnetic resonance imaging were performed before and after the training. Imaging data were analyzed using an independent component analysis approach. After training, both reading groups showed increased single-word contextual reading and reading comprehension scores. Greater positive correlations between the visual-processing component and the executive functions, attention, memory, or language components were found after training in children with reading difficulties. Training-related increases in connectivity between the visual and attention components and between the visual and executive function components were positively correlated with increased word reading and reading comprehension, respectively. Our findings suggest that the effect of the Reading Acceleration Program on basic cognitive domains can be detected even in the absence of an ongoing reading task.