“Shall We Play a Game?”: Improving Reading Through Action Video Games in Developmental Dyslexia

A Systematic Review on Visual-Processing Deficits in Neurofibromatosis Type 1: What Possible Impact on Learning to Read?

This systematic review aimed to examine the possible implication of visual-perceptual, visuo-attentional and oculomotor processing in the reading deficits frequently experienced by children with Neurofibromatosis type 1 (NF1), as previously shown in dyslexia. Using PRISMA methodological guidelines, we examined 49 studies; most of these reported visual-processing deficits in this population, raising the importance of directly studying the visuo-perceptual and visuo-attentional processes and eye-movement control involved in the learning-to-read process in NF1. The discussion provides a reflection for a better understanding of how visual-processing skills interact with reading deficits in NF1, as well as new avenues for their screening and care.

Action video games and posterior parietal cortex neuromodulation enhance both attention and reading in adults with developmental dyslexia

The impact of action video games on reading performance has been already demonstrated in individuals with and without neurodevelopmental disorders. The combination of action video games and posterior parietal cortex neuromodulation by a transcranial random noise stimulation could enhance brain plasticity, improving attentional control and reading skills also in adults with developmental dyslexia. In a double blind randomized controlled trial, 20 young adult nonaction video game players with developmental dyslexia were trained for 15 h with action video games. Half of the participants were stimulated with bilateral transcranial random noise stimulation on the posterior parietal cortex during the action video game training, whereas the others were in the placebo (i.e. sham) condition. Word text reading, pseudowords decoding, and temporal attention (attentional blink), as well as electroencephalographic activity during the attentional blink, were measured before and after the training. The action video game + transcranial random noise stimulation group showed temporal attention, word text reading, and pseudoword decoding enhancements and P300 amplitude brain potential changes. The enhancement in temporal attention performance was related with the efficiency in pseudoword decoding improvement. Our results demonstrate that the combination of action video game training with parietal neuromodulation increases the efficiency of visual attention deployment, probably reshaping goal-directed and stimulus-driven fronto-parietal attentional networks interplay in young adults with neurodevelopmental conditions.

Global visual attention SPAN in different video game genres

Video games, specifically action video games, have been demonstrated to be a useful tool in improving certain visual aspects in the general population. Visual attention span, the ability to simultaneously process multiple distinct visual elements during a single fixation, has been shown to improve among action video game players. The goal of this study was to verify that visual attention span is better not only in action video games, but also in other video game genres such as sports simulators or role-playing games. A total of 41 participants, aged 18 to 40 years old, were asked about the type of video games they were playing, name and genre, and the frequency of play. Visual attention span was assessed in all participants. Participants were divided into 4 groups according to the genre of video game they played. The total percentage of letter identification in the visual attention span was not significantly different between groups. A significant difference was found in the sixth position letter, and the right hemifield performance between groups, especially in sports simulators and action video game participants who showed a better performance. The action video game group showed a significant correlation between visual attention span performance and weekly hours played. Playing regularly different genres other than action video games can contribute to raise visual attention resources.

Investigating Visual Perception Impairments through Serious Games and Eye Tracking to Anticipate Handwriting Difficulties

Dysgraphia is a learning disability that causes handwritten production below expectations. Its diagnosis is delayed until the completion of handwriting development. To allow a preventive training program, abilities not directly related to handwriting should be evaluated, and one of them is visual perception. To investigate the role of visual perception in handwriting skills, we gamified standard clinical visual perception tests to be played while wearing an eye tracker at three difficulty levels. Then, we identified children at risk of dysgraphia through the means of a handwriting speed test. Five machine learning models were constructed to predict if the child was at risk, using the CatBoost algorithm with Nested Cross-Validation, with combinations of game performance, eye-tracking, and drawing data as predictors. A total of 53 children participated in the study. The machine learning models obtained good results, particularly with game performances as predictors (F1 score: 0.77 train, 0.71 test). SHAP explainer was used to identify the most impactful features. The game reached an excellent usability score (89.4 ± 9.6). These results are promising to suggest a new tool for dysgraphia early screening based on visual perception skills.

What's in a game: Video game visual-spatial demand location exhibits a double dissociation with reading speed

This research sought to clarify the nature of the relationship between video game experience, attention, and reading. Previous studies have suggested playing action video games can improve reading ability in children with dyslexia. Other research has linked video game experience with visual-spatial attention, and visual-spatial attention with reading. We hypothesized that the visual-spatial demands of video games may drive relationships with reading through attentional processing. In this experiment we used a hybrid attention/reading task to explore the relationship between video game visual-spatial demands, reading and attention. We also developed novel visual-spatial demand measures using participants' top five played video games for an individual-specific measure of visual demands. Peripheral visual demands in video games were associated with faster reading times, while central visual demands were associated with slower reading times for both phonetic decoding and lexical reading. In addition, video game experience in terms of hours spent playing video games each week interacted with the cueing effect size in the lexical reading condition, with experienced video game players exhibiting a larger cueing effect than participants with less video game experience. These results suggest that exposure to peripheral visual spatial demands in video games may be related to both lexical and sublexical reading processes in hybrid attentional reading tasks such as ours with skilled adult readers, which has implications not only for models of how ventral and dorsal stream reading and visual-spatial attention are integrated, but also for the development of dyslexia diagnostics and remediation.

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.

The Role of Auditory and Visual Components in Reading Training: No Additional Effect of Synchronized Visual Cue in a Rhythm-Based Intervention for Dyslexia

Based on the transfer effects of music training on the phonological and reading abilities of children with dyslexia, a computerized rhythmic intervention—the Rhythmic Reading Training (RRT)—was developed, in which reading exercises are combined with a rhythmic synchronization task. This rehabilitation program was previously tested in multiple controlled clinical trials, which confirmed its effectiveness in improving the reading skills of children and adolescents with dyslexia. In order to assess the specific contribution of the visual component of the training, namely, the presence of a visual cue supporting rhythmic synchronization, a controlled experimental study was conducted. Fifty-eight students with dyslexia aged 8 to 13 years were assigned to three conditions: (a) RRT auditory and visual condition, in which a visual cue was synchronized with the rhythmic stimulation; (b) RRT auditory-only condition, in which the visual cue was excluded; (c) no intervention. Comparisons of the participants’ performance before, after, and 3 months after the end of the intervention period revealed the significant immediate and long-term effect of both RRT conditions on reading, rapid naming, phonological, rhythmic, and attentional abilities. No significant differences were found between visual and auditory conditions, therefore showing no additional contribution of the visual component to the improvements induced by the RRT. Clinical Trial ID: NCT04995991.

Enhancing reading skills through a video game mixing action mechanics and cognitive training

In modern societies, training reading skills is fundamental since poor-reading children are at high risk of struggling both at school and in life. Reading relies not only on oral language abilities but also on several executive functions. Considering their importance for literacy, training executive functions-particularly, attentional control has been suggested as a promising way of improving reading skills. For this reason, we developed a video game-based cognitive intervention aimed at improving several facets of executive functions. This game is composed of mini-games that apply gamified versions of standard clinical exercises linked through a game environment with action video game dynamics. Here, in a study involving 151 typically reading children, we demonstrated that after this general-domain behavioural intervention reading abilities, as well as attentional and planning skills, were significantly improved. Our results showed that training attentional control can translate into better reading efficiency, maintained at a follow-up test 6 months later.

Improving Reading Through Videogames and Digital Apps: A Systematic Review

Background: The use of electronic interventions to improve reading is becoming a common resource. This systematic review aims to describe the main characteristics of randomized controlled trials or quasi-experimental studies that have used these tools to improve first-language reading, in order to highlight the features of the most reliable studies and guide future research. Methods: The whole procedure followed the PRISMA guidelines, and the protocol was registered before starting the process (doi: 10.17605/OSF.IO/CKM4N). Searches in Scopus, PubMed, Web of Science and an institutional reference aggregator (Unika) yielded 6,230 candidate articles. After duplicate removal, screening, and compliance of eligibility criteria, 55 studies were finally included. Results: They were research studies on improving first-language reading, both in children and adults, and including a control group. Thirty-three different electronic tools were employed, most of them in English, and studies were very diverse in sample size, length of intervention, and control tasks. Risk of bias was analyzed with the PEDro scale, and all studies had a medium or low risk. However, risk of bias due to conflicts of interest could not be evaluated in most studies, since they did not include a statement on this issue. Conclusion: Future research on this topic should include randomized intervention and control groups, with sample sizes over 65 per group, interventions longer than 15 h, and a proper disclosure of possible conflicts of interest. Systematic Review Registration: The whole procedure followed the PRISMA guidelines, and the protocol was registered before starting the process in the Open Science Framework (doi: 10.17605/OSF.IO/CKM4N).

The role of visual-spatial attention in reading development: a meta-analysis

The association between visual attention and reading development has been investigated as a possible core causal deficit in dyslexia, in addition to phonological awareness. This study aims to provide a meta-analytic review of the research on attentional processes and their relation to reading development, to examine the possible influence on it of orthographic depth, age, and attentional tasks (interpreted as serial or parallel processing indices). We included studies with participants up to 18 years of age that have considered the visual spatial attention orienting that sustains the serial visual analysis involved in the phonological pathway of decoding, and the visual attention span that supports the multielement parallel processing that is thought to influence lexical decoding. The results confirm a strong association between visual attention and reading development; we evaluate the evidence and discuss the possibility that visual attention processes play a causal role in determining individual differences in reading acquisition.

Action Video Games Enhance Attentional Control and Phonological Decoding in Children with Developmental Dyslexia

Reading acquisition is extremely difficult for about 5% of children because they are affected by a heritable neurobiological disorder called developmental dyslexia (DD). Intervention studies can be used to investigate the causal role of neurocognitive deficits in DD. Recently, it has been proposed that action video games (AVGs)-enhancing attentional control-could improve perception and working memory as well as reading skills. In a partial crossover intervention study, we investigated the effect of AVG and non-AVG training on attentional control using a conjunction visual search task in children with DD. We also measured the non-alphanumeric rapid automatized naming (RAN), phonological decoding and word reading before and after AVG and non-AVG training. After both video game training sessions no effect was found in non-alphanumeric RAN and in word reading performance. However, after only 12 h of AVG training the attentional control was improved (i.e., the set-size slopes were flatter in visual search) and phonological decoding speed was accelerated. Crucially, attentional control and phonological decoding speed were increased only in DD children whose video game score was highly efficient after the AVG training. We demonstrated that only an efficient AVG training induces a plasticity of the fronto-parietal attentional control linked to a selective phonological decoding improvement in children with DD.

Is excessive visual crowding causally linked to developmental dyslexia?

For about 10% of children reading acquisition is extremely difficult because they are affected by a heritable neurobiological disorder called developmental dyslexia (DD), mainly associated to an auditory-phonological disorder. Visual crowding is a universal phenomenon that impairs the recognition of stimuli in clutter, such as a letter in a word or a word in a text. Several studies have shown an excessive crowding in individuals with DD, but the causal link between excessive crowding and DD is not yet clearly established. An excessive crowding might be, indeed, a simple effect of DD due to reduced reading experience. The results of five experiments in 181 children reveal that: (i) an excessive crowding only at unattended locations characterizes an unselected group of children with DD (Experiment 1); (ii) an extra-large spaced text increases reading accuracy by reducing crowding in an unselected group of children with DD (Experiment 2); (iii) efficient attentional action video game trainings reduce crowding and accelerate reading speed in two unselected groups of children with DD (Experiment 3 and 4), and; (iv) pre-reading crowding longitudinally predicts future poor readers (Experiment 5). Our results show multiple causal links between visual crowding and learning to read. These findings provide new insights for a more efficient remediation and prevention for DD.

Visual short-term memory for coherent motion in video game players: evidence from a memory-masking paradigm

In this study, we investigated visual short-term memory for coherent motion in action video game players (AVGPs), non-action video game players (NAVGPs), and non-gamers (control group: CONs). Participants performed a visual memory-masking paradigm previously used with macaque monkeys and humans. In particular, we tested whether video game players form a more robust visual short-term memory trace for coherent moving stimuli during the encoding phase, and whether such memory traces are less affected by an intervening masking stimulus presented 0.2 s after the offset of the to-be-remembered sample. The results showed that task performance of all groups was affected by the masking stimulus, but video game players were affected to a lesser extent than controls. Modelling of performance values and reaction times revealed that video game players have a lower guessing rate than CONs, and higher drift rates than CONs, indicative of more efficient perceptual decisions. These results suggest that video game players exhibit a more robust VSTM trace for moving objects and this trace is less prone to external interference.

Improving action video games abilities increases the phonological decoding speed and phonological short-term memory in children with developmental dyslexia

Learning to read is extremely difficult for about 10% of the children because they are affected by a heritable neurobiological disorder called developmental dyslexia (DD). The causal role of cognitive deficits typically associated to DD can be investigated through intervention studies. It has been demonstrated that visual-attention and reading speed could be simultaneously improved by using action video game (AVG) training both in shallow and deep alphabetic orthographies. Here, in a clinical study we showed that after this general-domain behavioral intervention both the phonological decoding speed and phonological short-term memory were increased only in DD children in which their video game score was improved. These findings confirm that an AVG training enhances the efficiency of both visual and auditory processing. The plasticity of the multi-sensory attentional network could explain the reading and reading-related improvements induced by the AVG training in children with DD.

Sluggish dorsally-driven inhibition of return during orthographic processing in adults with dyslexia

Dyslexia (D) is a neurodevelopmental reading disorder characterized by phonological and orthographic deficits. Before phonological decoding, reading requires a specialized orthographic system for parallel letter processing that assigns letter identities to different spatial locations. The magnocellular-dorsal (MD) stream rapidly process the spatial location of visual stimuli controlling visuo-spatial attention. To investigate the visuo-spatial attention efficiency during orthographic processing, inhibition of return (IOR) was measured in adults with and without D in a lexical decision task. IOR is the delay in responding to stimuli displayed in a cued location after a long cue-target interval. Only adults with D did not showed IOR effect during letter-string recognition, despite the typical left-hemisphere specialization for word identification. A specific deficit in coherent-dot-motion perception confirmed an MD-stream disorder in adults with D. Our results suggest that adults with D might develop an efficient visual word form area, but a dorsal-attentional dysfunction impairs their reading fluency.

A different vision of dyslexia: Local precedence on global perception

Individuals perceive the wor(l)d hierarchically. Firsty, the global visual scene is processed by the right hemisphere, and later, the local features are perceived by the left hemisphere. Based on this hierarchical analysis, humans evolved unique communication ability: reading. However, for about 10% of people reading acquisition is extremely difficult, they are affected by a heritable neurodevelopmental disorder called dyslexia. Differences in perceiving the wor(l)d might be one of the causes of reading disabilities. Here we show multiple causal links between the global before local perception and learning to read. Five behavioral experiments in 353 children reveal that: (i) a local before global perception characterizes three independent groups of unselected children with dyslexia; (ii) two global before local perception trainings improve reading skills in children with dyslexia; and stringently (iii) pre-reading local before global perception longitudinally predicts future poor readers. Challenging the uni-causal and left-lateralized phonological explanation of dyslexia, our results demonstrate that learning to read depends also on an efficient right neural network for the global analysis of the visual scene. These results provide new insights in learning strategies and pave the way for early identification and possible prevention programs.

Visual motion and rapid auditory processing are solid endophenotypes of developmental dyslexia

Although a genetic component is known to have an important role in the etiology of developmental dyslexia (DD), we are far from understanding the molecular etiopathogenetic pathways. Reduced measures of neurobiological functioning related to reading (dis)ability, i.e. endophenotypes (EPs), are promising targets for gene finding and the elucidation of the underlying mechanisms. In a sample of 100 nuclear families with DD (229 offspring) and 83 unrelated typical readers, we tested whether a set of well-established, cognitive phenotypes related to DD [i.e. rapid auditory processing (RAP), rapid automatized naming (RAN), multisensory nonspatial attention and visual motion processing] fulfilled the criteria of the EP construct. Visual motion and RAP satisfied all testable criteria (i.e. they are heritable, associate with the disorder, co-segregate with the disorder within a family and represent reproducible measures) and are therefore solid EPs of DD. Multisensory nonspatial attention satisfied three of four criteria (i.e. it associates with the disorder, co-segregates with the disorder within a family and represents a reproducible measure) and is therefore a potential EP for DD. Rapid automatized naming is heritable but does not meet other criteria of the EP construct. We provide the first evidence of a methodologically and statistically sound approach for identifying EPs for DD to be exploited as a solid alternative basis to clinical phenotypes in neuroscience.

Action video games improve reading abilities and visual-to-auditory attentional shifting in English-speaking children with dyslexia

Dyslexia is characterized by difficulties in learning to read and there is some evidence that action video games (AVG), without any direct phonological or orthographic stimulation, improve reading efficiency in Italian children with dyslexia. However, the cognitive mechanism underlying this improvement and the extent to which the benefits of AVG training would generalize to deep English orthography, remain two critical questions. During reading acquisition, children have to integrate written letters with speech sounds, rapidly shifting their attention from visual to auditory modality. In our study, we tested reading skills and phonological working memory, visuo-spatial attention, auditory, visual and audio-visual stimuli localization, and cross-sensory attentional shifting in two matched groups of English-speaking children with dyslexia before and after they played AVG or non-action video games. The speed of words recognition and phonological decoding increased after playing AVG, but not non-action video games. Furthermore, focused visuo-spatial attention and visual-to-auditory attentional shifting also improved only after AVG training. This unconventional reading remediation program also increased phonological short-term memory and phoneme blending skills. Our report shows that an enhancement of visuo-spatial attention and phonological working memory, and an acceleration of visual-to-auditory attentional shifting can directly translate into better reading in English-speaking children with dyslexia.

Problems with visual statistical learning in developmental dyslexia

Previous research shows that dyslexic readers are impaired in their recognition of faces and other complex objects, and show hypoactivation in ventral visual stream regions that support word and object recognition. Responses of these brain regions are shaped by visual statistical learning. If such learning is compromised, people should be less sensitive to statistically likely feature combinations in words and other objects, and impaired visual word and object recognition should be expected. We therefore tested whether people with dyslexia showed diminished capability for visual statistical learning. Matched dyslexic and typical readers participated in tests of visual statistical learning of pairs of novel shapes that frequently appeared together. Dyslexic readers on average recognized fewer pairs than typical readers, indicating some problems with visual statistical learning. These group differences were not accounted for by differences in intelligence, ability to remember individual shapes, or spatial attention paid to the stimuli, but other attentional problems could play a mediating role. Deficiencies in visual statistical learning may in some cases prevent appropriate experience-driven shaping of neuronal responses in the ventral visual stream, hampering visual word and object recognition.

Action Video Games Improve Direction Discrimination of Parafoveal Translational Global Motion but Not Reaction Times

Playing action video games enhances visual motion perception. However, there is psychophysical evidence that action video games do not improve motion sensitivity for translational global moving patterns presented in fovea. This study investigates global motion perception in action video game players and compares their performance to that of non-action video game players and non-video game players. Stimuli were random dot kinematograms presented in the parafovea. Observers discriminated the motion direction of a target random dot kinematogram presented in one of the four visual quadrants. Action video game players showed lower motion coherence thresholds than the other groups. However, when the task was performed at threshold, we did not find differences between groups in terms of distributions of reaction times. These results suggest that action video games improve visual motion sensitivity in the near periphery of the visual field, rather than speed response.

Visual Illusions: An Interesting Tool to Investigate Developmental Dyslexia and Autism Spectrum Disorder

A visual illusion refers to a percept that is different in some aspect from the physical stimulus. Illusions are a powerful non-invasive tool for understanding the neurobiology of vision, telling us, indirectly, how the brain processes visual stimuli. There are some neurodevelopmental disorders characterized by visual deficits. Surprisingly, just a few studies investigated illusory perception in clinical populations. Our aim is to review the literature supporting a possible role for visual illusions in helping us understand the visual deficits in developmental dyslexia and autism spectrum disorder. Future studies could develop new tools - based on visual illusions - to identify an early risk for neurodevelopmental disorders.