Reading intervention and neuroplasticity: A systematic review and meta-analysis of brain changes associated with reading intervention

Alterations in neural activation in the ventral frontoparietal network during complex magnocellular stimuli in developmental dyslexia associated with READ1 deletion

BACKGROUND

An intronic deletion within intron 2 of the DCDC2 gene encompassing the entire READ1 (hereafter, READ1d) has been associated in both children with developmental dyslexia (DD) and typical readers (TRs), with interindividual variation in reading performance and motion perception as well as with structural and functional brain alterations. Visual motion perception -- specifically processed by the magnocellular (M) stream -- has been reported to be a solid and reliable endophenotype of DD. Hence, we predicted that READ1d should affect neural activations in brain regions sensitive to M stream demands as reading proficiency changes.

METHODS

We investigated neural activations during two M-eliciting fMRI visual tasks (full-field sinusoidal gratings controlled for spatial and temporal frequencies and luminance contrast, and sensitivity to motion coherence at 6%, 15% and 40% dot coherence levels) in four subject groups: children with DD with/without READ1d, and TRs with/without READ1d.

RESULTS

At the Bonferroni-corrected level of significance, reading skills showed a significant effect in the right polar frontal cortex during the full-field sinusoidal gratings-M task. Regardless of the presence/absence of the READ1d, subjects with poor reading proficiency showed hyperactivation in this region of interest (ROI) compared to subjects with better reading scores. Moreover, a significant interaction was found between READ1d and reading performance in the left frontal opercular area 4 during the 15% coherent motion sensitivity task. Among subjects with poor reading performance, neural activation in this ROI during this specific task was higher for subjects without READ1d than for READ1d carriers. The difference vanished as reading skills increased.

CONCLUSIONS

Our findings showed a READ1d-moderated genetic vulnerability to alterations in neural activation in the ventral attentive and salient networks during the processing of relevant stimuli in subjects with poor reading proficiency.

Association between parenting styles and dyslexia in primary school students: the mediating role of home literacy environment

Background

Despite an increasing amount of research on the relationship between parenting styles and neurodevelopmental disorders, there has been minimal focus on how parenting styles impact children's reading abilities. The aim of this study was to investigate the potential mediating role of the home literacy environment in the connection between parenting styles and dyslexia.

Methods

A total of 212 primary school students from grade 2-5 were recruited for this study. The Chinese Reading Ability Test was used to screen children with dyslexia. The home literacy environment was evaluated using a structured questionnaire that measured the frequency and quality of reading-related activities between parents and children. Egna Minnen Beträffande Uppfostran questionnaire was used to assess the parenting style, including emotional warmth, rejection, overprotection, and anxious rearing. It is a self-report tool filled out by the children themselves, used to assess their perceptions of their parents' parenting styles. The structural equation modeling was carried out to evaluate the direct, indirect, and total effects of parenting styles on dyslexia.

Results

Compared to control group, male children with dyslexia had lower scores in parenting styles characterized by emotional warmth, overprotecting and anxious rearing (p < 0.05), while female children with dyslexia only showed lower scores in anxious rearing (p < 0.05). Children with dyslexia lacked regular reading time (OR = 2.69, 95%CI: 1.04-6.97, p < 0.05), and have higher homework pressure compared to normal children (OR = 7.41, 95%CI: 1.45-37.82, p < 0.05). Additionally, emotional warmth, paternal overprotection and anxious rearing were negatively associated with dyslexia in children (all p < 0.05). Our findings indicate a strong correlation between dyslexia, home literacy environment, and parenting styles. In a structural equation model, the home literacy environment was identified as an independent mediator between parenting styles and dyslexia. The total effect of parenting styles on dyslexia is 0.55, with an indirect effect of 0.68 mediated by the home literacy environment.

Conclusion

The findings of this study indicate that home literacy environment serves as a mediator between parenting styles and dyslexia in children. This study highlights how parenting styles influence dyslexia, offering key insights for aiding dyslexic children and guiding effective interventions.

Cortical Structure in Pre-Readers at Cognitive Risk for Dyslexia: Baseline Differences and Response to Intervention

Early childhood is a critical period for structural brain development as well as an important window for the identification and remediation of reading difficulties. Recent research supports the implementation of interventions in at-risk populations as early as kindergarten or first grade, yet the neurocognitive mechanisms following such interventions remain understudied. To address this, we investigated cortical structure by means of anatomical MRI before and after a 12-week tablet-based intervention in: (1) at-risk children receiving phonics-based training (n = 29; n = 16 complete pre-post datasets), (2) at-risk children engaging with AC training (n = 24; n = 15 complete pre-post datasets) and (3) typically developing children (n = 25; n = 14 complete pre-post datasets) receiving no intervention. At baseline, we found higher surface area of the right supramarginal gyrus in at-risk children compared to typically developing peers, extending previous evidence that early anatomical differences exist in children who may later develop dyslexia. Our longitudinal analysis revealed significant post-intervention thickening of the left supramarginal gyrus, present exclusively in the intervention group but not the active control or typical control groups. Altogether, this study contributes new knowledge to our understanding of the brain morphology associated with cognitive risk for dyslexia and response to early intervention, which in turn raises new questions on how early anatomy and plasticity may shape the trajectories of long-term literacy development.

Short-term number sense training recapitulates long-term neurodevelopmental changes from childhood to adolescence

Number sense is fundamental to the development of numerical problem-solving skills. In early childhood, children establish associations between non-symbolic (e.g., a set of dots) and symbolic (e.g., Arabic numerals) representations of quantity. The developmental estrangement theory proposes that the relationship between non-symbolic and symbolic representations of quantity evolves with age, with increased dissociation across development. Consistent with this theory, recent research suggests that cross-format neural representational similarity (NRS) between non-symbolic and symbolic quantities is correlated with arithmetic fluency in children but not in adolescents. However, it is not known if short-term training (STT) can induce similar changes as long-term development. In this study, children aged 7-10 years underwent a theoretically motivated 4-week number sense training. Using multivariate neural pattern analysis, we investigated whether short-term learning could modify the relation between cross-format NRS and arithmetic skills. Our results revealed a significant correlation between cross-format NRS and arithmetic fluency in distributed brain regions, including the parietal and prefrontal cortices, prior to training. However, this association was no longer observed after training, and multivariate predictive models confirmed these findings. Our findings provide evidence that intensive STT during early childhood can promote behavioral improvements and neural plasticity that resemble and recapitulate long-term neurodevelopmental changes that occur from childhood to adolescence. More generally, our study contributes to our understanding of the malleability of number sense and highlights the potential for targeted interventions to shape neurodevelopmental trajectories in early childhood. RESEARCH HIGHLIGHTS: We tested the hypothesis that short-term number sense training induces the dissociation of symbolic numbers from non-symbolic representations of quantity in children. We leveraged a theoretically motivated intervention and multivariate pattern analysis to determine training-induced neurocognitive changes in the relation between number sense and arithmetic problem-solving skills. Neural representational similarity between non-symbolic and symbolic quantity representations was correlated with arithmetic skills before training but not after training. Short-term training recapitulates long-term neurodevelopmental changes associated with numerical problem-solving from childhood to adolescence.

Activation and functional connectivity of cerebellum during reading and during arithmetic in children with combined reading and math disabilities

Background

Reading and math constitute important academic skills, and as such, reading disability (RD or developmental dyslexia) and math disability (MD or developmental dyscalculia) can have negative consequences for children's educational progress. Although RD and MD are different learning disabilities, they frequently co-occur. Separate theories have implicated the cerebellum and its cortical connections in RD and in MD, suggesting that children with combined reading and math disability (RD + MD) may have altered cerebellar function and disrupted functional connectivity between the cerebellum and cortex during reading and during arithmetic processing.

Methods

Here we compared Control and RD + MD groups during a reading task as well as during an arithmetic task on (i) activation of the cerebellum, (ii) background functional connectivity, and (iii) task-dependent functional connectivity between the cerebellum and the cortex.

Results

The two groups (Control, RD + MD) did not differ for either task (reading, arithmetic) on any of the three measures (activation, background functional connectivity, task-dependent functional connectivity).

Conclusion

These results do not support theories that children's deficits in reading and math originate in the cerebellum.

White matter microstructural plasticity associated with educational intervention in reading disability

Children's reading progress typically slows during extended breaks in formal education, such as summer vacations. This stagnation can be especially concerning for children with reading difficulties or disabilities, such as dyslexia, because of the potential to exacerbate the skills gap between them and their peers. Reading interventions can prevent skill loss and even lead to appreciable gains in reading ability during the summer. Longitudinal studies relating intervention response to brain changes can reveal educationally relevant insights into rapid learning-driven brain plasticity. The current work focused on reading outcomes and white matter connections, which enable communication among the brain regions required for proficient reading. We collected reading scores and diffusion-weighted images at the beginning and end of summer for 41 children with reading difficulties who had completed either 1st or 2nd grade. Children were randomly assigned to either receive an intensive reading intervention (n = 26; Seeing Stars from Lindamood-Bell which emphasizes orthographic fluency) or be deferred to a wait-list group (n = 15), enabling us to analyze how white matter properties varied across a wide spectrum of skill development and regression trajectories. On average, the intervention group had larger gains in reading compared to the non-intervention group, who declined in reading scores. Improvements on a proximal measure of orthographic processing (but not other more distal reading measures) were associated with decreases in mean diffusivity within core reading brain circuitry (left arcuate fasciculus and left inferior longitudinal fasciculus) and increases in fractional anisotropy in the left corticospinal tract. Our findings suggest that responses to intensive reading instruction are related predominantly to white matter plasticity in tracts most associated with reading.

A volumetric asymmetry study of gray matter in individuals with and without dyslexia

Brain imaging work aimed at increased classification of dyslexia has underscored an important relationship between anterior (i.e., the inferior frontal gyrus; IFG) and posterior (i.e., superior temporal gyrus and supramarginal gyrus) brain regions. The extent to which the three components of the inferior frontal gyrus, namely the pars orbitalis, triangularis, and opercularis, are differentially related to the posterior regions, namely the superior temporal gyrus and supramarginal gyrus, needs further elucidation. Information about the nature of the anterior-posterior connections would facilitate our understanding of the neural underpinnings associated with dyslexia. Adult participants (N = 38; 16 with dyslexia) took part in an MRI study, whereby high-resolution structural scans were obtained. Volumetric asymmetry of the three regions of the IFG, the superior temporal gyrus, and the supramarginal gyrus was extracted. Significant differences were found for each of the three IFG regions, such that skilled readers had a greater leftward asymmetry of the orbitalis and triangularis, and greater rightward asymmetry of the opercularis, when compared to individuals with dyslexia. Furthermore, the pars triangularis was significantly associated with leftward asymmetry of the superior temporal gyrus for skilled but not dyslexic participants. For individuals with dyslexia, the cortical asymmetry of the IFG, and the corresponding connections with other reading-related brain regions, is inherently different from skilled readers. We discuss our findings in the context of the print-to-speech framework to further our understanding of the neural underpinnings associated with dyslexia.

Structural neural connectivity correlates with pre-reading abilities in preschool children

Pre-reading abilities are predictive of later reading ability and can be assessed before reading begins. However, the neural correlates of pre-reading abilities in young children are not fully understood. To address this, we examined 246 datasets collected in an accelerated longitudinal design from 81 children aged 2-6 years (age = 4.6 ± 0.98 years, 47 males). Children completed pre-reading assessments (NEPSY-II Phonological Processing and Speeded Naming) and underwent a diffusion magnetic resonance imaging (MRI) scan to assess white matter connectivity. We defined a core neural network of reading and language regions based on prior literature, and structural connections within this network were assessed using graph theory analysis. Linear mixed models accounting for repeated measures were used to test associations between children's pre-reading performance and graph theory measures for the whole bilateral reading network and each hemisphere separately. Phonological Processing scores were positively associated with global efficiency, local efficiency, and clustering coefficient in the bilateral and right hemisphere networks, as well as local efficiency and clustering coefficient in the left hemisphere network. Our findings provide further evidence that structural neural correlates of Phonological Processing emerge in early childhood, before and during early reading instruction.

Will you read how I will read? Naturalistic fMRI predictors of emergent reading

Despite reading being an essential and almost universal skill in the developed world, reading proficiency varies substantially from person to person. To study why, the fMRI field is beginning to turn from single-word or nonword reading tasks to naturalistic stimuli like connected text and listening to stories. To study reading development in children just beginning to read, listening to stories is an appropriate paradigm because speech perception and phonological processing are important for, and are predictors of, reading proficiency. Our study examined the relationship between behavioral reading-related skills and the neural response to listening to stories in the fMRI environment. Functional MRI were gathered in a 3T TIM-Trio scanner. During the fMRI scan, children aged approximately 7 years listened to professionally narrated common short stories and answered comprehension questions following the narration. Analyses of the data used inter-subject correlation (ISC), and representational similarity analysis (RSA). Our primary finding is that ISC reveals areas of increased synchrony in both high- and low-performing emergent readers previously implicated in reading ability/disability. Of particular interest are that several previously identified brain regions (medial temporal gyrus (MTG), inferior frontal gyrus (IFG), inferior temporal gyrus (ITG)) were found to "synchronize" across higher reading ability participants, while lower reading ability participants had idiosyncratic activation patterns in these regions. Additionally, two regions (superior frontal gyrus (SFG) and another portion of ITG) were recruited by all participants, but their specific timecourse of activation depended on reading performance. These analyses support the idea that different brain regions involved in reading follow different developmental trajectories that correlate with reading proficiency on a spectrum rather than the usual dichotomy of poor readers versus strong readers.

Characterization of Cortical and Subcortical Structural Brain Asymmetry in Adults with and without Dyslexia

Multiple cortical (planum temporale, supramarginal gyrus, fusiform gyrus) and subcortical (caudate, putamen, and thalamus) regions have shown different functional lateralization patterns for skilled vs. dyslexic readers. The extent to which skilled and dyslexic adult readers show differential structural lateralization remains to be seen. Method: Participants included 72 adults (N = 41 skilled; N = 31 dyslexic) who underwent a high-resolution MRI brain scan. The grey matter volume of the cortical and subcortical structures was extracted. Results: While there were clear behavioral differences between the groups, there were no differences in any of the isolated structures (i.e., either total size or asymmetry index) and limited evidence for any brain-behavior relationships. We did find a significant cortical-cortical relationship (p = 0.006) and a subcortical-subcortical relationship (p = 0.008), but not cross-over relationships. Overall, this work provides unique information on neural structures as they relate to reading in skilled and dyslexic readers.

Examination of common and unique brain regions for atypical reading and math: a meta-analysis

The purpose of this study is to identify consistencies across functional neuroimaging studies regarding common and unique brain regions/networks for individuals with reading difficulties (RD) and math difficulties (MD) compared to typically developing (TD) individuals. A systematic search of the literature, utilizing multiple databases, yielded 116 functional magnetic resonance imaging and positron emission tomography studies that met the criteria. Coordinates that directly compared TD with either RD or MD were entered into GingerALE (Brainmap.org). An activation likelihood estimate (ALE) meta-analysis was conducted to examine common and unique brain regions for RD and MD. Overall, more studies examined RD (n = 96) than MD (n = 20). Across studies, overactivation for reading and math occurred in the right insula and inferior frontal gyrus for atypically developing (AD) > TD comparisons, albeit in slightly different areas of these regions; however, inherent threshold variability across imaging studies could diminish overlying regions. For TD > AD comparisons, there were no similar or overlapping brain regions. Results indicate there were domain-specific differences for RD and MD; however, there were some similarities in the ancillary recruitment of executive functioning skills. Theoretical and practical implications for researchers and educators are discussed.

Macular Anatomy Differs in Dyslexic Subjects

The macula, as the central part of the retina, plays an important role in the reading process. However, its morphology has not been previously studied in the context of dyslexia. In this research, we compared the thickness of the fovea, parafovea and perifovea between dyslexic subjects and normal controls, in 11 retinal segmentations obtained by optical coherence tomography (OCT). With this aim, we considered the nine sectors of the Early Treatment Diabetic Retinopathy Study (ETDRS) grid and also summarized data from sectors into inner ring subfield (parafovea) and outer ring subfield (perifovea). The thickness in all the four parafoveal sectors was significantly thicker in the complete retina, inner retina and middle retina of both eyes in the dyslexic group, as well as other macular sectors (fovea and perifovea) in the inner nuclear layer (INL), inner plexiform layer (IPL), IPL + INL and outer plexiform layer + outer nuclear layer (OPL + ONL). Additionally, the inner ring subfield (parafovea), but not the outer ring subfield (perifovea), was thicker in the complete retina, inner retina, middle retina (INL + OPL + ONL), OPL + ONL, IPL + INL and INL in the dyslexic group for both eyes. In contrast, no differences were found between the groups in any of the sectors or subfields of the outer retina, retinal nerve fiber layer, ganglion cell layer or ganglion cell complex in any eye. Thus, we conclude from this exploratory research that the macular morphology differs between dyslexic and normal control subjects, as measured by OCT, especially in the parafovea at middle retinal segmentations.

Revisiting Multifactor Models of Dyslexia: Do They Fit Empirical Data and What Are Their Implications for Intervention?

Developmental dyslexia can be viewed as the result of the effects of single deficits or multiple deficits. This study presents a test of the applicability of a multifactor-interactive model (MFi-M) with a preliminary set of five variables corresponding to different neuropsychological functions involved in the reading process. The model has been tested on a sample of 55 school-age children with developmental dyslexia. The results show that the data fit a model in which each variable contributes to the reading ability in a non-additive but rather interactive way. These findings constitute a preliminary validation of the plausibility of the MFi-M, and encourage further research to add relevant factors and specify their relative weights. It is further discussed how subtype-based intervention approaches can be a suitable and advantageous framework for clinical intervention in a MFi-M perspective.

Growing Brains, Nurturing Minds-Neuroscience as an Educational Tool to Support Students' Development as Life-Long Learners

Compared to other primates, humans are late bloomers, with exceptionally long childhood and adolescence. The extensive developmental period of humans is thought to facilitate the learning processes required for the growth and maturation of the complex human brain. During the first two and a half decades of life, the human brain is a construction site, and learning processes direct its shaping through experience-dependent neuroplasticity. Formal and informal learning, which generates long-term and accessible knowledge, is mediated by neuroplasticity to create adaptive structural and functional changes in brain networks. Since experience-dependent neuroplasticity is at full force during school years, it holds a tremendous educational opportunity. In order to fulfill this developmental and learning potential, educational practices should be human-brain-friendly and "ride" the neuroplasticity wave. Neuroscience can inform educators about the natural learning mechanisms of the brain to support student learning. This review takes a neuroscientific lens to explore central concepts in education (e.g., mindset, motivation, meaning-making, and attention) and suggests two methods of using neuroscience as an educational tool: teaching students about their brain (content level) and considering the neuro-mechanisms of learning in educational design (design level).

The Functional Neuroanatomy of Reading Intervention

The present article reviews the literature on the brain mechanisms underlying reading improvements following behavioral intervention for reading disability. This includes evidence of neuroplasticity concerning functional brain activation, brain structure, and brain connectivity related to reading intervention. Consequently, the functional neuroanatomy of reading intervention is compared to the existing literature on neurocognitive models and brain abnormalities associated with reading disability. A particular focus is on the left hemisphere reading network including left occipito-temporal, temporo-parietal, and inferior frontal language regions. In addition, potential normalization/compensation mechanisms involving right hemisphere cortical regions, as well as bilateral sub-cortical and cerebellar regions are taken into account. The comparison of the brain systems associated with reading intervention and the brain systems associated with reading disability enhances our understanding of the neurobiological basis of typical and atypical reading development. All in all, however, there is a lack of sufficient evidence regarding rehabilitative brain mechanisms in reading disability, which we discuss in this review.

The Role of Brain Activity in Characterizing Successful Reading Intervention in Children With Dyslexia

Studies of reading intervention in dyslexia have shown changes in performance and in brain function. However, there is little consistency in the location of brain regions associated with successful reading gains in children, most likely due to variability/limitations in methodologies (study design, participant criteria, and neuroimaging procedures). Ultimately for the results to be meaningful, the intervention has to be successful, be assessed against a control, use rigorous statistics, and take biological variables (sex) into consideration. Using a randomized, crossover design, 31 children with dyslexia were assigned to a phonological- and orthographic-based tutoring period as well as a within-subjects control period to examine: (1) intervention-induced changes in behavior (reading performance) and in brain activity (during reading); and (2) behavioral and brain activity pre-intervention data that predicted intervention-induced gains in reading performance. We found gains in reading ability following the intervention, but not following the control period, with no effect of participants' sex. However, there were no changes in brain activity following the intervention (regardless of sex), suggesting that individual brain changes are too variable to be captured at the group level. Reading gains were not predicted by pre-intervention behavioral data, but were predicted by pre-intervention brain activity in bilateral supramarginal/angular gyri. Notably, some of this prediction was only found in females. Our results highlight the limitations of brain imaging in detecting the neural correlates of reading intervention in this age group, while providing further evidence for its utility in assessing eventual success of intervention, especially if sex is taken into consideration.