The link between reading ability and visual spatial attention across development

Genetic neurodevelopmental clustering and dyslexia

Dyslexia is a learning difficulty with neurodevelopmental origins, manifesting as reduced accuracy and speed in reading and spelling. It is substantially heritable and frequently co-occurs with other neurodevelopmental conditions, particularly attention deficit-hyperactivity disorder (ADHD). Here, we investigate the genetic structure underlying dyslexia and a range of psychiatric traits using results from genome-wide association studies of dyslexia, ADHD, autism, anorexia nervosa, anxiety, bipolar disorder, major depressive disorder, obsessive compulsive disorder, schizophrenia, and Tourette syndrome. Genomic Structural Equation Modelling (GenomicSEM) showed heightened support for a model consisting of five correlated latent genomic factors described as: F1) compulsive disorders (including obsessive-compulsive disorder, anorexia nervosa, Tourette syndrome), F2) psychotic disorders (including bipolar disorder, schizophrenia), F3) internalising disorders (including anxiety disorder, major depressive disorder), F4) neurodevelopmental traits (including autism, ADHD), and F5) attention and learning difficulties (including ADHD, dyslexia). ADHD loaded more strongly on the attention and learning difficulties latent factor (F5) than on the neurodevelopmental traits latent factor (F4). The attention and learning difficulties latent factor (F5) was positively correlated with internalising disorders (.40), neurodevelopmental traits (.25) and psychotic disorders (.17) latent factors, and negatively correlated with the compulsive disorders (-.16) latent factor. These factor correlations are mirrored in genetic correlations observed between the attention and learning difficulties latent factor and other cognitive, psychological and wellbeing traits. We further investigated genetic variants underlying both dyslexia and ADHD, which implicated 49 loci (40 not previously found in GWAS of the individual traits) mapping to 174 genes (121 not found in GWAS of individual traits) as potential pleiotropic variants. Our study confirms the increased genetic relation between dyslexia and ADHD versus other psychiatric traits and uncovers novel pleiotropic variants affecting both traits. In future, analyses including additional co-occurring traits such as dyscalculia and dyspraxia will allow a clearer definition of the attention and learning difficulties latent factor, yielding further insights into factor structure and pleiotropic effects.

Children with dyslexia show no deficit in exogenous spatial attention but show differences in visual encoding

In the search for mechanisms that contribute to dyslexia, the term "attention" has been invoked to explain performance in a variety of tasks, creating confusion since all tasks do, indeed, demand "attention." Many studies lack an experimental manipulation of attention that would be necessary to determine its influence on task performance. Nonetheless, an emerging view is that children with dyslexia have an impairment in the exogenous (automatic/reflexive) orienting of spatial attention. Here we investigated the link between exogenous attention and reading ability by presenting exogenous spatial cues in the multi-letter processing task-a task relevant for reading. The task was gamified and administered online to a large sample of children (N = 187) between 6 and 17 years. Children with dyslexia performed worse overall at rapidly recognizing and reporting strings of letters. However, we found no evidence for a difference in the utilization of exogenous spatial cues, resolving two decades of ambiguity in the field. Previous studies that claimed otherwise may have failed to distinguish attention effects from overall task performance or found spurious group differences in small samples. RESEARCH HIGHLIGHTS: We manipulated exogenous visual spatial attention using pre-cues in a task that is relevant for reading and we see robust task effects of exogenous attention. We found no evidence for a deficit in utilizing exogenous spatial pre-cues in children with dyslexia. However, children with dyslexia showed reduced recognition ability for all letter positions. Children with dyslexia were just as likely to make letter transposition errors as typical readers.

Reading problems and their connection with visual search and attention

Attention has been hypothesized to act as a sequential gating mechanism for the orderly processing of letters and words. These same visuoattentional processes are often assumed to partake in some but not all types of visual search. In the current study, 24 dyslexic and 36 typical readers completed an attentionally demanding visual conjunction search. Visual feature search served as an internal control. It has been suggested that reading problems should go hand in hand with specific problems in visual conjunction search-particularly elevated conjunction search slopes (time per search item)-often interpreted as a problem with visual attention. Results showed that reading problems were associated with slower visual search, especially conjunction search. However, reading deficits were not associated with increased conjunction search slopes but instead with increased search intercepts, traditionally not interpreted as reflecting attention. We discuss these results in the context of hypothesized visuoattentional problems in dyslexia. Remaining open to multiple interpretations of the data, the current study demonstrates that difficulties in visual search are associated with reading problems, in accordance with growing literature on visual cognition problems in developmental dyslexia.

Linguistic and attentional factors - Not statistical regularities - Contribute to word-selective neural responses with FPVS-oddball paradigms

Studies using frequency-tagging in electroencephalography (EEG) have dramatically increased in the past 10 years, in a variety of domains and populations. Here we used Fast Periodic Visual Stimulation (FPVS) combined with an oddball design to explore visual word recognition. Given the paradigm's high sensitivity, it is crucial for future basic research and clinical application to prove its robustness across variations of designs, stimulus types and tasks. This paradigm uses periodicity of brain responses to measure discrimination between two experimentally defined categories of stimuli presented periodically. EEG was recorded in 22 adults who viewed words inserted every 5 stimuli (at 2 Hz) within base stimuli presented at 10 Hz. Using two discrimination levels (deviant words among nonwords or pseudowords), we assessed the impact of relative frequency of item repetition (set size or item repetition controlled for deviant versus base stimuli), and of the orthogonal task (focused or deployed spatial attention). Word-selective occipito-temporal responses were robust at the individual level (significant in 95% of participants), left-lateralized, larger for the prelexical (nonwords) than lexical (pseudowords) contrast, and stronger with a deployed spatial attention task as compared to the typically used focused task. Importantly, amplitudes were not affected by item repetition. These results help understanding the factors influencing word-selective EEG responses and support the validity of FPVS-EEG oddball paradigms, as they confirm that word-selective responses are linguistic. Second, they show its robustness against design-related factors that could induce statistical (ir)regularities in item rate. They also confirm its high individual sensitivity and demonstrate how it can be optimized, using a deployed rather than focused attention task, to measure implicit word recognition processes in typical and atypical populations.

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.

The effect of attention shifting on Chinese children's word reading in primary school

BACKGROUND

This study explored the effects of attention shifting on Chinese children's word reading.

OBJECTIVE

The sample consisted of 87 fourth-grade children from Shaoxing City, China.

METHODS

The students completed measures of the attention shifting task, reading accuracy test, reading fluency test, and rapid automatized naming test.

RESULTS

The results showed that reading fluency was significantly correlated with attention shifting scores, specifically with tag1 and tag6 (ps < 0.05). The reading accuracy score was also significantly correlated with tag6 (p < 0.05). According to the regression analysis of attention shifting on word reading, even when controlling for rapid automatic naming, attention shifting significantly affected word reading fluency at approximately 600 ms (p = .011). Attention shifting did not affect children's word reading accuracy.

SHORT CONCLUSION

These findings suggest that attention shifting is significantly associated with children's word reading. Educators should focus on developing children's attention shifting to improve their word reading ability.

Towards a dynamic, comprehensive conceptualization of dyslexia

Here we build from the central strength of the existing definition of dyslexia-its emphasis on neurobiological origins-and proffer a set of seven core principles for a new, more comprehensive conceptualization of dyslexia. These principles derive from two major research directions: (1) the still evolving history of attempts to explain dyslexia, including in varied writing systems; and (2) the study of the reading brain circuit, its development, and its genetic and environmental influences. What emerges from connecting these two directions is a dynamic conceptualization of dyslexia that incorporates the extensive research on the heterogeneity of dyslexia and the interdependent contributions of multiple biological and socio-cultural risk and preventive factors. A new definition of dyslexia, therefore, needs to transcend both past unitary characterizations and past assumptions based largely on the English orthography. Such a conceptualization references the ways that different languages interact with the reading brain circuit to produce different sources of reading failure. Similarly, the characteristics and consequences of dyslexia that have been considered as secondary sequela (e.g., reduced reading comprehension, social-emotional issues) should be part of a more comprehensive narrative. Of critical importance, any definition of dyslexia should clarify persisting misconceptions that associate dyslexia with a lack of intelligence, potential to learn, or talents. Thus, the overall purpose of such a definition should serve as an instrument of knowledge and an enduring reason for pursuing growth in reading for the individual, the educator, and the public.

Adults at low reading level are sluggish in disengaging spatial attention

An increasing number of studies show that attentional shifting is a primary contributor during the process of learning to read. However, it remains unclear what is the relationship between attentional shifting and word-reading ability in adult readers whose reading skills have matured. More fundamentally, how attentional shifting affects individuals' reading ability remains poorly understood. To address these issues, we grouped adult readers by the level of Chinese character reading and examined the time course of attentional shifting by setting up multiple stimulus-onset asynchronies (SOAs) in the Posner cue-target paradigm. Based on the phonological mediation hypothesis, we also measured multiple abilities involving phonological processing (i.e., rapid automatic naming and phonological awareness). Results showed that compared with adults at the high reading level, adults at the low reading level showed a selective impairment of attentional disengagement. Rapid automatic naming of Chinese characters played a partially mediating role in the association between attentional shifting and word reading. These results provided evidence for the phonological mediation hypothesis, and suggest that attentional shifting affects word reading by influencing phonological processing in adult Chinese readers.

Visual field asymmetries vary between adolescents and adults

For human adults, visual perception varies around isoeccentric locations (with polar angle at a constant distance from the center of gaze). The same visual information yields better performance along the horizontal than vertical meridian (horizontal vertical anisotropy, HVA) and along the lower than upper vertical meridian (vertical meridian asymmetry, VMA). For children, performance is better along the horizontal than vertical meridian (HVA) but does not differ between the lower and the upper vertical meridian. Here, we investigated whether the extent of the HVA varies and the VMA emerges and fully develops during adolescence, or whether the VMA only emerges in adulthood. We found that for adolescents, performance yields both HVA and VMA, but both are less pronounced than those for adults.

Neural Correlates of Visual Attention and Short-Term Memory in Children with Reading Difficulty

Visual attention and memory of 20 children with reading difficulty (M_age = 134 months), 24 chronological (M_age = 138 months) and 19 reading-age controls (M_age = 92 months) were examined using object substitution masking; mask offset delay increases visual attention and visual short-term memory demands. ERP amplitude differences in the N1 (alerting), N2pc (N2-posterior-contralateral; selective attention), and SPCN (sustained posterior contralateral negativity; memory load) were expected between groups. Chronological controls performed best, but ERP results were mixed. No group differences were found for N1 or N2pc. SPCN showed enhanced negativity in reading difficulty, indicating greater memory load and anomalous inhibition.

Lateralization of orthographic processing in fixed-gaze and natural reading conditions

Lateralized processing of orthographic information is a hallmark of proficient reading. However, how this finding obtained for fixed-gaze processing of orthographic stimuli translates to ecologically valid reading conditions remained to be clarified. To address this shortcoming, here we assessed the lateralization of early orthographic processing in fixed-gaze and natural reading conditions using concurrent eye-tracking and EEG data recorded from young adults without reading difficulties. Sensor-space analyses confirmed the well-known left-lateralized negative-going deflection of fixed-gaze EEG activity throughout the period of early orthographic processing. At the same time, fixation-related EEG activity exhibited left-lateralized followed by right-lateralized processing of text stimuli during natural reading. A strong positive relationship was found between the early leftward lateralization in fixed-gaze and natural reading conditions. Using source-space analyses, early left-lateralized brain activity was obtained in lateraloccipital and posterior ventral occipito-temporal cortices reflecting letter-level processing in both conditions. In addition, in the same time interval, left-lateralized source activity was found also in premotor and parietal brain regions during natural reading. While brain activity remained left-lateralized in later stages representing word-level processing in posterior and middle ventral temporal regions in the fixed-gaze condition, fixation-related source activity became stronger in the right hemisphere in medial and more anterior ventral temporal brain regions indicating higher-level processing of orthographic information. Although our results show a strong positive relationship between the lateralization of letter-level processing in the two reading modes and suggest lateralized brain activity as a general marker for processing of orthographic information, they also clearly indicate the need for reading research in ecologically valid conditions to identify the neural basis of visuospatial attentional, oculomotor and higher-level processes specific to natural reading.

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.

Horizontal Gaze Palsy with Progressive Scoliosis with Overlapping Epilepsy and Learning Difficulties: A Case Report

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare congenital disease characterized by the absence of horizontal gaze movements, progressive scoliosis, and typical brain, cerebellum, and medullary malformations. Here we describe a pediatric HGPPS case with overlapping epilepsy and learning difficulties. A 6-year-old girl was admitted to the University Hospital of Bari for the onset of a tonic–clonic seizure. Electroencephalogram showed slow and sharp waves on the right side with the tendency to diffuse. Brain magnetic resonance imaging demonstrated malformations compatible with HGPPS. Ophthalmological and orthopedic evaluations confirmed conjugate horizontal gaze palsy and mild thoracolumbar scoliosis. Neuropsychological assessment attested normal intelligence but serious difficulties in reading and writing. In spite of neuroradiological malformations, visual difficulties, and spinal deformities, literature data are limited about any coexisting neurocognitive HGPPS symptoms. Literature data regarding such topics are very limited. If, on the one hand, the coexistence of such symptoms can be interpreted as occasional, it could support the idea that they could fall within a spectrum of HGPPS anomalies. In addition to the standard investigations, the activation of specific neuropsychological assessment programs could help interventions improve the specialist care and the quality of life of HGPPS patients.

Spatial attention in encoding letter combinations

Reading requires the correct identification of letters and letter positions within words. Selective attention is, therefore, required to select chunks of the text for sequential processing. Despite the extensive literature on visual attention, the well-known effects of spatial cues in simple perceptual tasks cannot inform us about the role of attention in a task as complex as reading. Here, we systematically manipulate spatial attention in a multi-letter processing task to understand the effects of spatial cues on letter encoding in typical adults. Overall, endogenous (voluntary) cue benefits were larger than exogenous (reflexive). We show that cue benefits are greater in the left than in the right visual field and larger for the most crowded letter positions. Endogenous valid cues reduced errors due to confusing letter positions more than misidentifications, specifically for the most crowded letter positions. Therefore, shifting endogenous attention along a line of text is likely an important mechanism to alleviate the effects of crowding on encoding letters within words. Our results help set the premise for constructing theories about how specific mechanisms of attention support reading development in children. Understanding the link between reading development and attention mechanisms has far-reaching implications for effectively addressing the needs of children with reading disabilities.

Multisensory deficits in dyslexia may result from a locus coeruleus attentional network dysfunction

A fundamental educational requirement of beginning reading is to learn, access, and rapidly process associations between novel visuospatial symbols and their phonological representations in speech. Children with difficulties in such cross-modal integration are often divided into dyslexia subtypes, based on whether their primary problem is with the written or spoken component of decoding. The present review suggests that starting in infancy, perceptions of audiovisual speech are integrated by mutual oscillatory phase-resetting between sensory cortices, and throughout development visual and auditory experiences are coupled into unified perceptions. Entirely separate subtypes are incompatible with this view. Visual or auditory deficits will invariably affect processing to some degree in both domains. It is suggested that poor auditory/visual integration may be diagnostic for both forms of dyslexia, stemming from an encoding weakness in the early cross-sensory binding of audiovisual speech. The review presents a model of dyslexia as a dysfunction of the large-scale ventral and dorsal attention networks controlling such binding. Excessive glutamatergic neuronal excitability of the attention networks by the Locus coeruleus-norepinephrine system may interfere with multisensory integration, with deleterious effects on the acquisition of reading by degrading graphene/phoneme conversion.

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.

Reading: The Confluence of Vision and Language

The scientific study of reading has a rich history that spans disciplines from vision science to linguistics, psychology, cognitive neuroscience, neurology, and education. The study of reading can elucidate important general mechanisms in spatial vision, attentional control, object recognition, and perceptual learning, as well as the principles of plasticity and cortical topography. However, literacy also prompts the development of specific neural circuits to process a unique and artificial stimulus. In this review, we describe the sequence of operations that transforms visual features into language, how the key neural circuits are sculpted by experience during development, and what goes awry in children for whom learning to read is a struggle. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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.

An Evolutionary Perspective of Dyslexia, Stress, and Brain Network Homeostasis

Evolution fuels interindividual variability in neuroplasticity, reflected in brain anatomy and functional connectivity of the expanding neocortical regions subserving reading ability. Such variability is orchestrated by an evolutionarily conserved, competitive balance between epigenetic, stress-induced, and cognitive-growth gene expression programs. An evolutionary developmental model of dyslexia, suggests that prenatal and childhood subclinical stress becomes a risk factor for dyslexia when physiological adaptations to stress promoting adaptive fitness, may attenuate neuroplasticity in the brain regions recruited for reading. Stress has the potential to blunt the cognitive-growth functions of the predominantly right hemisphere Ventral and Dorsal attention networks, which are primed with high entropic levels of synaptic plasticity, and are critical for acquiring beginning reading skills. The attentional networks, in collaboration with the stress-responsive Default Mode network, modulate the entrainment and processing of the low frequency auditory oscillations (1-8 Hz) and visuospatial orienting linked etiologically to dyslexia. Thus, dyslexia may result from positive, but costly adaptations to stress system dysregulation: protective measures that reset the stress/growth balance of processing to favor the Default Mode network, compromising development of the attentional networks. Such a normal-variability conceptualization of dyslexia is at odds with the frequent assumption that dyslexia results from a neurological abnormality. To put the normal-variability model in the broader perspective of the state of the field, a traditional evolutionary account of dyslexia is presented to stimulate discussion of the scientific merits of the two approaches.

Attention extends beyond single words in beginning readers

A common notion is that during the first stages of learning to read, attention is narrowly focused so as to encompass only a single or a few letters. In skilled adult readers, however, attention extends beyond single words. The latter is evidenced by faster recognition of words that have many letters in common with surrounding words, along with correlations between such integration effects and measures of attention. These premises suggest that the distribution of attention gradually increases as a function of reading skill, and that this progression can be mapped by measuring spatial integration effects across the course of reading development. The latter was undertaken in the present study, in which we employed the flanker paradigm combined with the lexical decision task. Children in grades 1-6 (N = 113) were shown central target words flanked by various types of orthographically related and unrelated flanking stimuli. Against expectations, significant effects of flanker relatedness on word recognition speed were found in the youngest children, and this effect was not modulated by reading age. Our results challenge the notion that attention is focused on single letters in beginning readers, and instead suggest that, from the earliest stages of reading development, orthographic processing can extend beyond single words.