Efficacy of dynamic visuo-attentional interventions for reading in dyslexic and neurotypical children: A systematic review

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.

Prismatic adaptation coupled with cognitive training as novel treatment for developmental dyslexia: a randomized controlled trial

Despite intense and costly treatments, developmental dyslexia (DD) often persists into adulthood. Several brain skills unrelated to speech sound processing (i.e., phonology), including the spatial distribution of visual attention, are abnormal in DD and may represent possible treatment targets. This study explores the efficacy in DD of rightward prismatic adaptation (rPA), a visuomotor adaptation technique that enables visuo-attentive recalibration through shifts in the visual field induced by prismatic goggles. A digital intervention of rPA plus cognitive training was delivered weekly over 10 weeks to adolescents with DD (aged 13-17) assigned either to treatment (N = 35) or waitlist (N = 35) group. Efficacy was evaluated by repeated measures MANOVA assessing changes in working memory index (WMI), processing speed index (PSI), text reading speed, and words/pseudowords reading accuracy. rPA treatment was significantly more effective than waitlist (p ≤ 0.001; ηp2 = 0.815). WMI, PSI, and reading speed increased in the intervention group only (p ≤ 0.001, ηp2 = 0.67; p ≤ 0.001, ηp2 = 0.58; p ≤ 0.001, ηp2 = 0.29, respectively). Although modest change was detected for words and pseudowords accuracy in the waitlist group only (words: p ≤ 0.001, d = 0.17, pseudowords: p = 0.028; d = 0.27), between-group differences were non-significant. rPA-coupled cognitive training enhances cognitive and reading abilities in adolescents with DD. This innovative approach could have implications for early remedial treatment.

Action video games normalise the phonemic awareness in pre-readers at risk for developmental dyslexia

Action video-games (AVGs) could improve reading efficiency, enhancing not only visual attention but also phonological processing. Here we tested the AVG effects upon three consolidated language-based predictors of reading development in a sample of 79 pre-readers at-risk and 41 non-at-risk for developmental dyslexia. At-risk children were impaired in either phonemic awareness (i.e., phoneme discrimination task), phonological working memory (i.e., pseudoword repetition task) or rapid automatized naming (i.e., RAN of colours task). At-risk children were assigned to different groups by using an unequal allocation randomization: (1) AVG (n = 43), (2) Serious Non-Action Video Game (n = 11), (3) treatment-as-usual (i.e., speech therapy, n = 11), and (4) waiting list (n = 14). Pre- and post-training comparisons show that only phonemic awareness has a significantly higher improvement in the AVG group compared to the waiting list, the non-AVG, and the treatment-as-usual groups, as well as the combined active groups (n = 22). This cross-modal plastic change: (i) leads to a recovery in phonemic awareness when compared to the not-at-risk pre-readers; (ii) is present in more than 80% of AVG at-risk pre-readers, and; (iii) is maintained at a 6-months follow-up. The present findings indicate that this specific multisensory attentional training positively affects how phonemic awareness develops in pre-readers at risk for developmental dyslexia, paving the way for innovative prevention programs.

Effects of online tDCS and hf-tRNS on reading performance in children and adolescents with developmental dyslexia: a study protocol for a cross sectional, within-subject, randomized, double-blind, and sham-controlled trial

Background

Developmental Dyslexia (DD) is a brain-based developmental disorder causing severe reading difficulties. The extensive data on the neurobiology of DD have increased interest in brain-directed approaches, such as transcranial direct current stimulation (tDCS), which have been proposed for DD. While positive outcomes have been observed, results remain heterogeneous. Various methodological approaches have been employed to address this issue. However, no studies have compared the effects of different transcranial electrical stimulation techniques (e.g., tDCS and transcranial random noise stimulation, tRNS), on reading in children and adolescents with DD.

Methods

The present within-subject, double-blind, and sham-controlled trial aims to investigate the effects of tDCS and hf-tRNS on reading in children and adolescents with DD. Participants will undergo three conditions with a one-week interval session: (A) single active tDCS session; (B) single active hf-tRNS session; and (C) single sham session (tDCS/hf-tRNS). Left anodal/right cathodal tDCS and bilateral tRNS will be applied over the temporo-parietal regions for 20 min each. Reading measures will be collected before and during each session. Safety and blinding parameters will be recordered.

Discussion

We hypothesize that tRNS will demonstrate comparable effectiveness to tDCS in improving reading compared to sham conditions. Additionally, we anticipate that hf-tRNS will exhibit a similar safety profile to tDCS. This study will contribute novel insights into the effectiveness of hf-tRNS, expediting the validation of brain-based treatments for DD.

The challenge of remote treatment in neuropsychological intervention for reading and spelling in dyslexia: A prospective observational cohort study

Telemedicine approaches have proved to be valuable solutions for the delivery of treatment for many health-related issues, and crucial during the pandemics. Nonetheless, the efficacy of such Web-based practices in developmental dyslexia needs to be thoroughly evaluated. To this aim, the effects of a multi-componential program for neuropsychological intervention in dyslexia delivered as an outpatient program were compared with those obtained with a remotely delivered, Web-based treatment, based on the same methodological principles and delivered with the same duration and intensity. The treatment-related changes obtained with a combination of visual hemisphere-specific stimulation and training of visual-spatial attention through action video games, were compared to those obtained through remote treatment via the Tachidino Web-based platform. Both treatments had a duration of 4 weeks. The same battery of reading and phonemic awareness tests was delivered in presence, before and after treatment, as well as at 6-months follow-up. User satisfaction was assessed through parents and user questionnaires. Both treatments were significantly and similarly effective in improving reading speed, reading accuracy, and writing accuracy. No reduction in the effects was observed after treatment discontinuation. The Web-based treatment may thus offer a valid alternative to in-person intervention, optimizing the flexibility, capillary diffusion and cost-effectiveness of intervention.

Remote treatment of developmental dyslexia: how ADHD comorbidity, clinical history and treatment repetition may affect its efficacy

Introduction

Tachidino is a web-based platform for remote treatment of reading and spelling disorders. The purpose of the present study was to investigate the possible impact of different clinical conditions on the efficacy of treatment. The focus was on possible ADHD comorbidity-related effects on the outcomes of the Tachidino treatment, and the impact of previous treatments, such as speech and language therapy or the repetition of the same Tachidino program.

Methods

136 children with developmental dyslexia received four-weeks treatment via the Tachidino platform. Improvements in reading and writing scores were compared between different subgroups.

Results

No gross differences emerged in treatment effectiveness between groups of children. Children receiving treatment improved significantly more than untreated children.

Discussion

Treatment with Tachidino brought significant benefits for all children, irrespective of comorbidity, clinical history or treatment repetition. Comparison with an untreated control group (waiting list) made it possible to exclude that improvement was due to test-retest learning effects.

Oculomotor Rehabilitation Improves Reading Abilities in Dyslexic Children With Concurrent Eye Movement Abnormalities

The oculomotor abnormalities have been reported in some dyslexic children. The purpose of the study was to evaluate the effects of oculomotor rehabilitation on the reading performance of dyslexic children. Subjects were 50 dyslexic children. Those with oculomotor abnormalities (n = 30) were randomly assigned into 2 groups matched for age. The case group received oculomotor rehabilitation. The rehabilitation program consists of 3 different exercises. The reading and dyslexia tests were performed before and after the intervention. The correct scores of reading tests in the case group posttest increased significantly compared with the control group, and there is a significant difference between the two groups (P = .001). The positive effects of oculomotor rehabilitation on the reading performance of dyslexic children confirmed that the oculomotor program could be a practical tool for improving reading performance in dyslexic children.

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.

The effect of online visual games on visual perception, oculomotor, and balance skills of children with developmental dyslexia during the COVID-19 pandemic

PURPOSE

To evaluate the effect of online visual games on the balance, visual perception, and oculomotor skills of children with developmental dyslexia during the COVID-19 pandemic.

METHODS

In this single-blind randomized clinical trial, 50 children with developmental dyslexia, aged 7 to 11 years, were recruited from rehabilitation centers in Tehran, Iran, using a convenience sampling strategy. Participants were randomly divided into two groups: intervention (25) and control (25), with close matching based on sex, age, IQ, and type of disease. The interventions consisted of web-based online computer games focusing on visual perception and oculomotor skills. Outcome measures included the Test of Visual Perception Skills-Revised, the Pediatric Balance Scale, and videonystagmography. The Wechsler Intelligence Scale for Children-IV and the Reading and Dyslexia Test were used to evaluate IQ and reading skills, respectively.

RESULTS

The intervention group exhibited significant post-intervention improvements in the Test of Visual Perception Skills-Revised, tracking gain, saccade latency, and saccade velocity scores (all P < 0.001). In contrast, the control group showed no significant differences in these tests in pre- and post-intervention (all P > 0.05). Notably, post-intervention comparisons between the groups revealed significant differences in smooth pursuit eye movements (P < 0.001), saccade latency (P = 0.027), and saccade velocity (P < 0.001). The Pediatric Balance Scale scores remained unchanged in both groups post-intervention (intervention: P = 0.317; control: P = 0.999). Game face validity was affirmed with impact scores above 1.5 for all items, suggesting that the games were straightforward, clear, and relevant.

CONCLUSION

Online visual games enhanced oculomotor and visual perception skills in children with dyslexia but did not influence balance skills.

Effects of a developmental dyslexia remediation protocol based on the training of audio-phonological cognitive processes in dyslexic children with high intellectual potential: study protocol for a multiple-baseline single-case experimental design

BACKGROUND

The significant prevalence of children with high intellectual potential (HIP) in the school-age population and the high rate of comorbidity with learning disabilities such as dyslexia has increased the demand for speech and language therapy and made it more complex. However, the management of dyslexic patients with high intellectual potential (HIP-DD) is poorly referenced in the literature. A large majority of studies on HIP-DD children focus on the screening and diagnosis of developmental dyslexia, but only a few address remediation. Developmental dyslexia is a severe and persistent disorder that affects the acquisition of reading and implies the impairment of several underlying cognitive processes. These include deficits in Categorical Perception, Rapid Automatized Naming, and phonological awareness, particularly phonemic awareness. Some authors claim that HIP-DD children's underlying deficits mainly concern rapid automatized naming and phonological awareness. Thus, the purpose of this study is to present a remediation protocol for developmental dyslexia in HIP-DD children. This protocol proposes to compare the effects on reading skills of an intensive intervention targeting categorical perception, rapid automatized naming, and phonemic analysis versus standard speech therapy remediation in HIP-DD children.

METHODS

A multiple-baseline single-case experimental design (A1BCA2) will be proposed to 4 French HIP-DD patients for a period of 30 weeks. Intervention phases B and C correspond to categorical perception training and rapid automatized naming training. During phases B and C, each training session will be associated with phonemic analysis training and a reading and writing task. At inclusion, a speech and language, psychological, and neuropsychological assessment will be performed to define the four patients' profiles. Patients will be assigned to the different baseline lengths using a simple computerized randomization procedure. The duration of the phases will be counterbalanced. The study will be double blinded. A weekly measurement of phonological and reading skills will be performed for the full duration of the study.

DISCUSSION

The purpose of this protocol is to observe the evolution of reading skills with each type of intervention. From this observation, hypotheses concerning the remediation of developmental dyslexia in HIP-DD children can be tested. The strengths and limitations of the study are discussed.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04028310 . Registered on July 18, 2019. Version identifier is no. ID RCB 2019-A01453-54, 19-HPNCL-02, 07/18/2019.

The Role of Visual Factors in Dyslexia

What are the causes of dyslexia? Decades of research reflect a determined search for a single cause where a common assumption is that dyslexia is a consequence of problems with converting phonological information into lexical codes. But reading is a highly complex activity requiring many well-functioning mechanisms, and several different visual problems have been documented in dyslexic readers. We critically review evidence from various sources for the role of visual factors in dyslexia, from magnocellular dysfunction through accounts based on abnormal eye movements and attentional processing, to recent proposals that problems with high-level vision contribute to dyslexia. We believe that the role of visual problems in dyslexia has been underestimated in the literature, to the detriment of the understanding and treatment of the disorder. We propose that rather than focusing on a single core cause, the role of visual factors in dyslexia fits well with risk and resilience models that assume that several variables interact throughout prenatal and postnatal development to either promote or hinder efficient reading.

Multimodal intervention in 8- to 13-year-old French dyslexic readers: Study protocol for a randomized multicenter controlled crossover trial

BACKGROUND

Developmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual's cognitive profile as part of a longitudinal intervention study.

METHODS

This multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an "intention-to-treat" analysis will be performed on the children who quit the trial before the end.

DISCUSSION

The main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT04028310. Registered on July 18, 2019.

The visual basis of reading and reading difficulties

Most of our knowledge about the neural networks mediating reading has derived from studies of developmental dyslexia (DD). For much of the 20th C. this was diagnosed on the basis of finding a discrepancy between children's unexpectedly low reading and spelling scores compared with their normal or high oral and non-verbal reasoning ability. This discrepancy criterion has now been replaced by the claim that the main feature of dyslexia is a phonological deficit, and it is now argued that we should test for this to identify dyslexia. However, grasping the phonological principle is essential for all learning to read; so every poor reader will show a phonological deficit. The phonological theory does not explain why dyslexic people, in particular, fail; so this phonological criterion makes it impossible to distinguish DD from any of the many other causes of reading failure. Currently therefore, there is no agreement about precisely how we should identify it. Yet, if we understood the specific neural pathways that underlie failure to acquire phonological skills specifically in people with dyslexia, we should be able to develop reliable means of identifying it. An important, though not the only, cause in people with dyslexia is impaired development of the brain's rapid visual temporal processing systems; these are required for sequencing the order of the letters in a word accurately. Such temporal, "transient," processing is carried out primarily by a distinct set of "magnocellular" (M-) neurones in the visual system; and the development of these has been found to be impaired in many people with dyslexia. Likewise, auditory sequencing of the sounds in a word is mediated by the auditory temporal processing system whose development is impaired in many dyslexics. Together these two deficits can therefore explain their problems with acquiring the phonological principle. Assessing poor readers' visual and auditory temporal processing skills should enable dyslexia to be reliably distinguished from other causes of reading failure and this will suggest principled ways of helping these children to learn to read, such as sensory training, yellow or blue filters or omega 3 fatty acid supplements. This will enable us to diagnose DD with confidence, and thus to develop educational plans targeted to exploit each individual child's strengths and compensate for his weaknesses.

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.

Enhanced reading abilities is modulated by faster visual spatial attention

Research has shown improved reading following visual magnocellular training in individuals with dyslexia. Many studies have demonstrated how the magnocellular pathway controls visual spatial attention. Therefore, we have investigated the relationship between magnocellular pathway and visual spatial attention deficits in dyslexia in order to better understand how magnocellular-based interventions may help children to learn to read. Magnocellular function, visual spatial attention, and reading abilities of thirty elementary school students with dyslexia, aged between 8 and 10, were measured. The experimental group received magnocellular-based visual motion training for 12 sessions, while the control group received neutral sessions. All tests were repeated at the end of the training and after 1 month. The magnocellular functioning, visual spatial attention, and reading abilities of the experimental group improved significantly compared to the controls. Additionally, improvement in reaction time of invalid conditions predicted improvements in saccadic eye movements. We conclude that visual magnocellular training improved saccadic eye movement control, visual spatial orientation, and reading ability.

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.

Remote Neuropsychological Intervention for Developmental Dyslexia with the Tachidino Platform: No Reduction in Effectiveness for Older Nor for More Severely Impaired Children

Tachidino is a web-platform for remote treatment of reading and writing disorders. A total of 91 children with developmental dyslexia and/or dysorthographia participated in the present study and received Tachidino treatment. The purpose of the study was to compare results obtained after four weeks treatment and a six-month follow-up in older versus younger children and in more versus less severely impaired children (separately subdividing them according to reading speed, reading accuracy, and writing accuracy). The results showed no difference in improvement for reading accuracy and speed in the three age groups, but children below 9 years improved more than older children in writing accuracy. Regarding severity groups, children with more severe initial impairments improved more than children with less severe impairments. Additionally, the results were confirmed after controlling for spurious effects due to use of Z-scores and regression to the mean. The findings are discussed in terms of their theoretical and practical implications.

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.

Short Vestibular and Cognitive Training Improves Oral Reading Fluency in Children with Dyslexia

(1) Background: This study explored the effect of short vestibular and cognitive training on the reading speed in dyslexic children. (2) Methods: The reading speed was evaluated by using a reading test (Évaluation de la Lecture en FluencE, ELFE) in a crossover design before (baseline) and after vestibular training (post VT) and no vestibular training (post no VT). Nineteen dyslexic children (9.48 ± 0.15 years) participated in the study. The vestibular and cognitive training (software developed by BeonSolution S.r.l.) consisted in four exercises presented on a Wacom tablet 10″ done for 16 min per session two times per week for four weeks; each exercise was composed of eight levels with increased difficulty. (3) Results: Following vestibular and cognitive training, dyslexic children increased their reading speed; interestingly, such an increase persisted at least one month after training. (4) Conclusions: Vestibular and cognitive training could improve the vestibular network, which is well known for being involved in several cognition functions leading to reading improvement in dyslexic children. Adaptive mechanisms could be responsible for maintaining such improvement for at least one month.

Action video game training improves text reading accuracy, rate and comprehension in children with dyslexia: a randomized controlled trial

Dynamic visual attention training using Action Video Games (AVGs) is a promising intervention for dyslexia. This study investigated the efficacy of 5 h (10 × 30 min) of AVG training in dyslexic children (aged 8–13) using ‘Fruit Ninja’, while exploring whether increasing attentional and eye movement demands enhanced AVG effectiveness. Regular (AVG-R; n = 22) and enhanced AVG training (AVG+; n = 23) were compared to a treatment-as-usual comparison group (n = 19) on reading, rapid naming, eye movements and visuo-temporal processing. Playing ‘Fruit Ninja’ for only 5 h significantly improved reading accuracy, rate, comprehension and rapid naming of both AVG groups, compared to the comparison group, though increasing attentional demands did not enhance AVG efficacy. Participants whose low contrast magnocellular-temporal processing improved most following training also showed significantly greater improvement in reading accuracy. The findings demonstrate a clear role for visual attention in reading and highlight the clinical applicability of AVGs as a fun, motivational and engaging intervention for dyslexia.

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.

Responses to Navon tasks differ across development and between tasks with differing attentional demands

Navon hierarchical stimuli are designed to measure responses to the global level (grouped local elements, e.g. a forest) and the local level (individuated local elements, e.g. trees) of a visual scene. Cross-sectional evidence suggests that there are developmental changes in global and local processing. We examined global and local processing in 135 typically developing children in Year 1 (aged 5-6 year), Year 3 (aged 7-8 years), and Year 5 (aged 9-10 years). Participants completed a range of Navon tasks, each with different attentional demands. The design of the Navon stimuli remained constant across the tasks, ensuring that any task-related differences were not due to stimulus characteristics. Sixty children from Years 1 and 3 repeated the testing session two years later. Linear mixed model analyses combined longitudinal and cross-sectional data to assess developmental changes and the influence of attentional task demands on responses. The results revealed differing patterns of global and local processing responses according to Year group and attentional task demands. We found some evidence of developmental change in responses from a relatively more local advantage to a relatively more global advantage, which is consistent with the literature. However, the age at which this transition occurred varied across the tasks. We conclude that responses to hierarchical Navon stimuli are modulated by attentional task characteristics which mask any underlying global or local processing advantage.

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.

Flicker fusion thresholds as a clinical identifier of a magnocellular-deficit dyslexic subgroup

The magnocellular-dorsal system is well isolated by high temporal frequency. However, temporal processing thresholds have seldom been explored in developmental dyslexia nor its subtypes. Hence, performances on two, four-alternative forced-choice achromatic flicker fusion threshold tasks modulated at low (5%) and high (75%) temporal contrast were compared in dyslexic and neurotypical children individually matched for age and intelligence (8–12 years, n = 54 per group). As expected, the higher modulation resulted in higher flicker fusion thresholds in both groups. Compared to neurotypicals, the dyslexic group displayed significantly lower ability to detect flicker at high temporal frequencies, both at low and high temporal contrast. Yet, discriminant analysis did not adequately distinguish the dyslexics from neurotypicals, on the basis of flicker thresholds alone. Rather, two distinct dyslexic subgroups were identified by cluster analysis – one characterised by significantly lower temporal frequency thresholds than neurotypicals (referred to as ‘Magnocellular-Deficit’ dyslexics; 53.7%), while the other group (‘Magnocellular-Typical’ dyslexics; 46.3%) had comparable thresholds to neurotypicals. The two dyslexic subgroups were not differentially associated with phonological or naming speed subtypes and showed comparable mean reading rate impairments. However, correlations between low modulation flicker fusion threshold and reading rate for the two subgroups were significantly different (p = .0009). Flicker fusion threshold performances also showed strong classification accuracy (79.3%) in dissociating the Magnocellular-Deficit dyslexics and neurotypicals. We propose that temporal visual processing impairments characterize a previously unidentified subgroup of dyslexia and suggest that measurement of flicker fusion thresholds could be used clinically to assist early diagnosis and appropriate treatment recommendations for dyslexia.

How the Science of Reading Informs 21st-Century Education

The science of reading should be informed by an evolving evidence base built upon the scientific method. Decades of basic research and randomized controlled trials of interventions and instructional routines have formed a substantial evidence base to guide best practices in reading instruction, reading intervention, and the early identification of at-risk readers. The recent resurfacing of questions about what constitutes the science of reading is leading to misinformation in the public space that may be viewed by educational stakeholders as merely differences of opinion among scientists. Our goals in this paper are to revisit the science of reading through an epistemological lens to clarify what constitutes evidence in the science of reading and to offer a critical evaluation of the evidence provided by the science of reading. To this end, we summarize those things that we believe have compelling evidence, promising evidence, or a lack of compelling evidence. We conclude with a discussion of areas of focus that we believe will advance the science of reading to meet the needs of all children in the 21st century.

Visual Attentional Training Improves Reading Capabilities in Children with Dyslexia: An Eye Tracker Study During a Reading Task

Dyslexia is a specific disorder in reading abilities. The aim of this study was to explore whether a short visual attentional training could improve reading capabilities in children with reading disorders by changing their oculomotor characteristics. Two groups (G1 and G2) of 25 children with reading disabilities and who are matched in IQ (intelligence quotient), sex, and age participated in the study. The allocation of a subject to a specific group (G1 = experimental group; G2 = control group) was generated in an unpredictable random sequence. The reading task was recorded twice for G1, i.e., before (T1) and after (T2) 10 min of visual attentional training. Training consisted of oculomotor tasks (saccades and pursuits movements) and searching tasks (three different exercises). For G2, the two reading tasks at T1 and T2 were done at an interval of 10 min instead. We found that at T1, oculomotor performances during reading were statistically similar for both groups of children with reading disabilities (G1 and G2). At T2, the group G1 only improved oculomotor capabilities significantly during reading; in particular, children read faster, and their fixation time was shortest. We conclude that short visual attentional training could improve the cortical mechanisms responsible for attention and reading capabilities. Further studies on a larger number of dyslexic children will be necessary in order to explore the effects of different training types on the visual attentional span given its important role on the orienting and focusing visuospatial attention and on the oculomotor performance in children with dyslexia.

Misunderstandings about developmental dyslexia: a historical overview

Developmental dyslexia is a reading disorder unrelated to intellectual disability, inadequate teaching systems or poor motivation for schooling. The first attempts to understand such difficulty of learning to read, connected the problem to a primary 'visual defect'. Since then, several models have been developed. In the last decades, autopsy and histopathological studies on the brain of developmental dyslexics provided neuroanatomical evidence of structural and morphological differences between the normal and dyslexic brains. Furthermore, neuroimaging studies allowed to understand the neural systems of reading and dyslexia. According to more recent studies, developmental dyslexia appears as a language-related neurodevelopmental disorder with a deficit in phonological decoding and visuospatial organization of the language code. Therefore, dyslexia is viewed as a multicomponential and complex disorder. Consequently, rehabilitation should be aimed at both the recovery of linguistic decoding processes and the improvement of visuo-spatial and attentional processes. This brief overview should be a valuable tool for a deeper understanding of dyslexic disorder. Literature searches in Medline, PsycINFO, EMBASE, Scopus, PubMed, Web of Science identified one hundred articles focusing attention on how this disorder has been considered over the years.

The Effectiveness of Interventions for Developmental Dyslexia: Rhythmic Reading Training Compared With Hemisphere-Specific Stimulation and Action Video Games

Developmental dyslexia is a very common learning disorder causing an impairment in reading ability. Although the core deficit underlying dyslexia is still under debate, significant agreement is reached in the literature that dyslexia is related to a specific deficit in the phonological representation of speech sounds. Many studies also reported an association between reading skills and music. These findings suggest that interventions aimed at enhancing basic auditory skills of children with DD may impact reading abilities. However, music education alone failed to produce improvements in reading skills comparable to those resulting from traditional intervention methods for DD. Therefore, a computer-assisted intervention method, called Rhythmic Reading Training (RRT), which combines sublexical reading exercises with rhythm processing, was implemented. The purpose of the present study was to compare the effectiveness of RRT and that of an intervention resulting from the combination of two yet validated treatments for dyslexia, namely, Bakker’s Visual Hemisphere-Specific Stimulation (VHSS) and the Action Video Game Training (AVG). Both interventions, administered for 13 h over 9 days, significantly improved reading speed and accuracy of a group of Italian students with dyslexia aged 8–14. However, each intervention program produced improvements that were more evident in specific reading parameters: RRT was more effective for improvement of pseudoword reading speed, whereas VHSS + AVG was more effective in increasing general reading accuracy. Such different effects were found to be associated with different cognitive mechanisms, namely, phonological awareness for RRT and rapid automatized naming for VHSS + AVG, thus explaining the specific contribution of each training approach. Clinical Trial registration: ClinicalTrials.gov NCT02791841.

Local perception impairs the lexical reading route

Human perception of a visual scene is hierarchically organized. Such rapid, albeit coarse, global processing allows people to create a useful context in which local details can be successively allocated. Lack of the typical hierarchical global-to-local visual processing is longitudinally predictive of future reading difficulties in pre-readers, which suggests that an atypical local perception can interfere with reading skill acquisition. Global and local Navon tasks were used to induce a transient perceptual priming before a reading-aloud task. We tested the effect of an atypical local perception on lexical and sublexical reading routes in typical adult readers. Local (vs. global) priming resulted in a slower phonological access to irregular, relative to regular, words. By contrast, pseudoword reading was not affected by local (vs. global) perceptual priming. Our findings demonstrate that, in typical adult readers, local priming impairs the fast processing of the letter string useful for lexical reading.

Eye Movements During RAN as an Operationalization of the RAN-Reading "Microcosm"

Rapid Automatized Naming (RAN) is a strong predictor of reading aloud, though there is little agreement on what underpins RAN or how it relates to reading. Some theorize phonological skills, while others suggest that RAN reflects the “microcosm” of cognitive and attentional processes also required for reading, with more recent research using eye movements in an attempt to study this relationship. In the current study, we aimed to extend previous investigations to identify whether the temporal patterns of eye movements predict RAN and can, therefore, be established as a method to study the cognitive processes underlying RAN that could then be utilized to elucidate the relationship of RAN to reading. A Gazepoint eye tracker was used to record the eye movements of 93 learner readers aged 5–8 years (M age = 7.00) while performing a custom computerized alphabetic RAN task. Text reading accuracy, comprehension and rate; nonverbal intelligence; and phonological awareness abilities were also assessed. Regression analyses showed that, independently of phonological awareness, eye movements [Fixation Count (FC) and Fixation Duration (FD)] measured during RAN tasks were highly reflective of children’s rapid naming performance (92.8%). Both mean FC and mean FD during RAN tasks also predicted text reading accuracy (36.3%), comprehension (31.6%), and rate (36.2%) scores, and in predicting these text reading skills there was a high level of shared variance with RAN performance. In a sub-sample of participants, longer average FDs and counts independently discriminated children with reading difficulties (n = 18; aged 7–9) from neurotypical children matched for age (n = 18), but not from younger neurotypical children matched for reading level (n = 18; aged 5–6). Together, these results suggest that the analysis of eye movements recorded during RAN allows for the operationalization of many of the spatially and temporally-bound cognitive and attentional processes that underpin the RAN, and a step towards elucidating its relationship to reading.

Caffeine improves text reading and global perception

BACKGROUND

Reading is a unique human skill. Several brain networks involved in this complex skill mainly involve the left hemisphere language areas. Nevertheless, nonlinguistic networks found in the right hemisphere also seem to be involved in sentence and text reading. These areas do not deal with phonological information, but are involved in verbal and nonverbal pattern information processing. The right hemisphere is responsible for global processing of a scene, which is needed for developing reading skills.

AIMS

Caffeine seems to affect global pattern processing specifically. Consequently, our aim was to discover if it could enhance text reading skill.

METHODS

In two mechanistic studies (n=24 and n=53), we tested several reading skills, global and local perception, alerting, spatial attention and executive functions, as well as rapid automatised naming and phonological memory, using a double-blind, within-subjects, repeated-measures design in typical young adult readers.

RESULTS

A single dose of 200 mg caffeine improved global processing, without any effect on local information processing, alerting, spatial attention and executive or phonological functions. This improvement in global processing was accompanied by faster text reading speed of meaningful sentences, whereas single word/pseudoword or pseudoword text reading abilities were not affected. These effects of caffeine on reading ability were enhanced by mild sleep deprivation.

CONCLUSIONS

These findings show that a small quantity of caffeine could improve global processing and text reading skills in adults.

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

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

Visual training could be useful for improving reading capabilities in dyslexia

The term dyslexia originated in 1887 when an ophthalmologist described the difficulty of learning to read. After more than a century of research, we still do not know the etiology of such pathology. Several hypotheses have been suggested to explain dyslexia and in the present article we will describe in detail the visual attentional deficits reported in dyslexia. Reading is a complex cognitive process during which several mechanisms are involved (visual perception, eye movements -saccades and fixations-, semantic and linguistic abilities); consequently, a deficit in one of these different components could cause impairment in reading acquisition. In children with dyslexia, we observed abnormal oculomotor patterns during reading: frequent saccades of small amplitude, long-term fixation, high number of saccades to the left (retro-saccades), and poor binocular coordination during and after the saccades. These results suggest a deficit of visual information processing as well as an immaturity of the interaction between the saccade and vergence systems. In the present review, we will discuss different methods that use short periods of visual rehabilitation or text manipulation, and by using an eye tracker in order to obtain objective information on eye movement's performance during reading, assist in improved reading performance of dyslexic children.

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.