Neural changes following remediation in adult developmental dyslexia

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.

The Role of Neural and Genetic Processes in Learning to Read and Specific Reading Disabilities: Implications for Instruction

To learn to read, the brain must repurpose neural systems for oral language and visual processing to mediate written language. We begin with a description of computational models for how alphabetic written language is processed. Next, we explain the roles of a dorsal sublexical system in the brain that relates print and speech, a ventral lexical system that develops the visual expertise for rapid orthographic processing at the word level, and the role of cognitive control networks that regulate attentional processes as children read. We then use studies of children, adult illiterates learning to read, and studies of poor readers involved in intervention, to demonstrate the plasticity of these neural networks in development and in relation to instruction. We provide a brief overview of the rapid increase in the field's understanding and technology for assessing genetic influence on reading. Family studies of twins have shown that reading skills are heritable, and molecular genetic studies have identified numerous regions of the genome that may harbor candidate genes for the heritability of reading. In selected families, reading impairment has been associated with major genetic effects, despite individual gene contributions across the broader population that appear to be small. Neural and genetic studies do not prescribe how children should be taught to read, but these studies have underscored the critical role of early intervention and ongoing support. These studies also have highlighted how structured instruction that facilitates access to the sublexical components of words is a critical part of training the brain to read.

Spreading of phonological activation in dyslexia throughout life

We studied the developmental course of the spreading of phonological activation in individuals with and without dyslexia by means of a phonological version of the Deese/Roediger-McDermott false memory task. The false memory effect is assumed to reflect the spreading of activation from the presented stimuli to similar words in the lexicon. We assessed 35 volunteers with dyslexia and a group of matched controls with ages ranging from 6 to 58 years. They were first presented with six lists of ten two-syllable words each, all of which shared one syllable with a reference unpresented word. Then, they answered a recognition questionnaire including 24 presented words, 18 phonologically related unpresented words, and 12 unrelated unpresented words. False recognition of phonologically related words increased with age in the control group but stayed at very low levels in the dyslexia group. Our study indicates the existence of a deficit in the spreading of phonological activation in individuals with dyslexia throughout life.

Reduced pattern similarity in brain activation during orthographic processing in children with developmental dyslexia

Intra-individual variability of neural response has been found to be negatively associated with cognitive proficiency and automaticity. However, whether developmental dyslexia (DD) is marked by greater intra-individual neural variability remains unclear. Using a multivariate approach and dual-control group design, the current study aims to examine whether the pattern similarity of brain activation during a visual spelling task is abnormal in children with DD compared to age control and reading control children. We found that there was reduced intra-subject pattern similarity at the left occipito-temporal regions in children with DD than both control groups, suggesting a neural signature of DD. Furthermore, we found that pattern similarity was positively associated with stability of reaction time and reading fluency in both children with DD and typical control children, suggesting that neural stability supports behavioral stability and automaticity during reading.

An investigation of white matter properties as they relate to spelling behaviour in skilled and impaired readers

RESULTS

While the inferior longitudinal fasciculus was more strongly related to spelling behaviour in skilled adults, the uncinate fasciculus was more strongly related to spelling behaviour in impaired adults. We found strong left lateralization of the arcuate fasciculus and inferior longitudinal fasciculus in both groups. However, lateralization of the inferior frontal occipital fasciculus was more strongly related to spelling response time behaviour in skilled adults, whereas lateralization of the uncinate fasciculus was more strongly related to spelling accuracy behaviour in the impaired adults.

CONCLUSION

This study provides some useful information for understanding the underlying white matter pathways that support spelling in skilled and impaired adults and underscore the advantage of adopting multiple spelling tasks and outcomes (i.e., response time and accuracy) to better characterize brain-behaviour relationships in skilled and impaired adults.

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 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.

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

Behavioral research supports the efficacy of intervention for reading disability, but the brain mechanisms underlying improvement in reading are not well understood. Here, we review 39 neuroimaging studies of reading intervention to characterize links between reading improvement and changes in the brain. We report evidence of changes in activation, connectivity, and structure within the reading network, and right hemisphere, frontal and sub-cortical regions. Our meta-analysis of changes in brain activation from pre- to post- reading intervention in eight studies did not yield any significant effects. Methodological heterogeneity among studies may contribute to the lack of significant meta-analytic findings. Based on our qualitative synthesis, we propose that brain changes in response to intervention should be considered in terms of interactions among distributed cognitive, linguistic and sensory systems, rather than via a "normalized" vs. "compensatory" dichotomy. Further empirical research is needed to identify effects of moderating factors such as features of intervention programs, neuroimaging tasks, and individual differences among participants.

Using Neurofeedback to Restore Inter-Hemispheric Imbalance: A Study Protocol for Adults With Dyslexia

Neurofunctional models of developmental dyslexia (DD) point out disruption of the left-lateralized reading network. In individuals with DD, the left temporo-parietal (TP) regions are underactivated during reading tasks and a dysfunctional activation of the contralateral regions is reported. After a successful reading intervention, left TP lateralization was found to be increased in children with DD. Previous studies measured the effect of modulating the excitability of the left TP cortex using non-invasive brain stimulation (NIBS) in individuals with reading difficulties, showing significant reading improvements. NIBS exclusion criteria and safety guidelines may limit its application in settings without medical supervision and in younger populations. Neurofeedback (NF) training could be an alternative intervention method for modulating the inter-hemispheric balance of the temporal–parietal regions in DD. To date, the effect of NF on reading has been scarcely investigated. Few protocols increasing beta activity in underactivated areas showed improved reading outcomes. However, none of the previous studies designed the NF intervention based on a neurofunctional model of DD. We aim to propose a study protocol for testing the efficacy of a NF training specifically designed for inducing a functional hemispheric imbalance of the tempo-parietal regions in adults with DD. A randomized clinical trial aimed at comparing two experimental conditions is described: (a) Enhancing left beta/theta power ratio NF training in combination with reducing right beta/theta power ratio NF training and (b) sham NF training.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier [NCT04989088].

Hypothetical molecular interconnection between type 2 diabetes and dyslexia

BACKGROUND

Dyslexia is one of the most common learning disabilities, especially among children. Type 2 diabetes is a metabolic disorder that affects a large population globally, with metabolic disorders. There have been several genes that are identified as causes of Dyslexia, and in recent studies, it has been found out that some of those genes are also involved in several metabolic pathways. For several years, it has been known that type 2 diabetes causes several neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. Furthermore, in several studies, it was suggested that type 2 diabetes also has some associations with learning disabilities. This raises the question of whether "Is there a connection between type 2 diabetes and dyslexia?". In this study, this question is elaborated by linking their developmental processes via bioinformatics analysis about these two diseases individually and collectively.

RESULT

The literature review for dyslexia and type two diabetes was completed. As the result of this literature review, the genes that are associated to type 2 diabetes and dyslexia were identified. The biological pathways of dyslexia, and dyslexia associated genes, type 2 diabetes, and type 2 diabetes associated genes were identified. The association of these genes, regarding to their association with pathways were analysed, and using STRING database the gene associations were analysed and identified.

CONCLUSION

The findings of this research included the interaction analysis via gene association, co-expression and protein-protein interaction. These findings clarified the interconnection between dyslexia and type 2 diabetes in molecular level and it will be the beginning of an answer regarding to the relationship between T2D and dyslexia. Finally, by improving the understanding this paper aims to open the way for the possible future approach to examine this hypothesis.

Convergent and divergent brain structural and functional abnormalities associated with developmental dyslexia

Brain abnormalities in the reading network have been repeatedly reported in individuals with developmental dyslexia (DD); however, it is still not totally understood where the structural and functional abnormalities are consistent/inconsistent across languages. In the current multimodal meta-analysis, we found convergent structural and functional alterations in the left superior temporal gyrus across languages, suggesting a neural signature of DD. We found greater reduction in grey matter volume and brain activation in the left inferior frontal gyrus in morpho-syllabic languages (e.g. Chinese) than in alphabetic languages, and greater reduction in brain activation in the left middle temporal gyrus and fusiform gyrus in alphabetic languages than in morpho-syllabic languages. These language differences are explained as consequences of being DD while learning a specific language. In addition, we also found brain regions that showed increased grey matter volume and brain activation, presumably suggesting compensations and brain regions that showed inconsistent alterations in brain structure and function. Our study provides important insights about the etiology of DD from a cross-linguistic perspective with considerations of consistency/inconsistency between structural and functional alterations.

Delaying feedback compensates for impaired reinforcement learning in developmental dyslexia

A theoretical framework suggests that developmental dyslexia is characterized by abnormalities in brain structures underlying the procedural learning and memory systems while the declarative learning and memory systems are presumed to remain intact or even enhanced (Procedural Deficit Hypothesis). This notion has been supported by a substantial body of research, which focused on each system independently. However, less attention has been paid to interactions between these memory systems which may provide insights as to learning situations and conditions in which learning in dyslexia can be improved. The current study was undertaken to examine these important but unresolved issues. To this end, probabilistic reinforcement learning and episodic memory tasks were examined in participants with dyslexia and neurotypicals simultaneously within a single task. Feedback timing presentation was manipulated, building on prior research indicating that delaying feedback timing shifts striatal-based probabilistic learning, to become more hippocampal-dependent. It was hypothesized that if the procedural learning and memory systems are impaired in dyslexia, performance will be impaired under conditions that encourage procedural memory engagement (immediate feedback trials) but not under conditions that promote declarative memory processing (long delayed feedback trials). It was also predicted that the ability to incidentally acquire episodic information would be preserved in dyslexia. The results supported these predictions. Participants with dyslexia were impaired in probabilistic learning of cue-outcome associations compared to neurotypicals in an immediate feedback condition, but not when feedback on choices was presented after a long delay. Furthermore, participants with dyslexia demonstrated similar performance to neurotypicals in a task requiring incidental episodic memory formation. These findings attest to a dissociation between procedural-based and declarative-based learning in developmental dyslexia within a single task, a finding that adds discriminative validity to the Procedural Deficit Hypothesis. Just as important, the present findings suggest that training conditions designed to shift the load from midbrain/striatal systems to declarative memory mechanisms have the potential to compensate for impaired learning in developmental dyslexia.

Structural brain dynamics across reading development: A longitudinal MRI study from kindergarten to grade 5

Primary education is the incubator for learning academic skills that help children to become a literate, communicative, and independent person. Over this learning period, nonlinear and regional changes in the brain occur, but how these changes relate to academic performance, such as reading ability, is still unclear. In the current study, we analyzed longitudinal T1 MRI data of 41 children in order to investigate typical cortical development during the early reading stage (end of kindergarten-end of grade 2) and advanced reading stage (end of grade 2-middle of grade 5), and to detect putative deviant trajectories in children with dyslexia. The structural brain change was quantified with a reliable measure that directly calculates the local morphological differences between brain images of two time points, while considering the global head growth. When applying this measure to investigate typical cortical development, we observed that left temporal and temporoparietal regions belonging to the reading network exhibited an increase during the early reading stage and stabilized during the advanced reading stage. This suggests that the natural plasticity window for reading is within the first years of primary school, hence earlier than the typical period for reading intervention. Concerning neurotrajectories in children with dyslexia compared to typical readers, we observed no differences in gray matter development of the left reading network, but we found different neurotrajectories in right IFG opercularis (during the early reading stage) and in right isthmus cingulate (during the advanced reading stage), which could reflect compensatory neural mechanisms.

Improving reading skills in children with dyslexia: efficacy studies on a newly proposed remedial intervention-repeated reading with vocal music masking (RVM)

In this work, two different studies are examined to evaluate the effectiveness of a novel intervention program for the improvement of reading ability in children with dyslexia, known as repeated reading with vocal music masking (RVM). The proposed remedial approach is inspired by Breznitz's original work. The studies assess a 5-week program of intensive RVM training in a pre-post-test clinical paradigm, as well as a longitudinal paradigm where it is compared to 8 months of the standard remediation program (SRP). The results of both studies support the efficacy of the newly proposed RVM method. Notably in the longitudinal study, the reading speed of children, as well as related phonological, visuo-attentional, and cognitive skills, and attitudes toward reading, were measured regularly. Significant improvements in reading efficiency and related skills were observed, as well as greater motivation to read after RVM training. A modeling of the data specifically linked executive and processing speed skills to be involved in RVM training, suggesting that RVM may help rebalance the phonological and orthographic coding procedures necessary for efficient reading. The short, intensive, and focused nature of RVM training makes it a viable and attractive intervention for clinical practice. As preliminary results are promising, RVM training may prove to be a valuable tool that clinicians can call upon to effectively treat reading fluency disorders, especially when standard programs do not provide results.

Multifactorial pathways facilitate resilience among kindergarteners at risk for dyslexia: A longitudinal behavioral and neuroimaging study

Recent efforts have focused on screening methods to identify children at risk for dyslexia as early as preschool/kindergarten. Unfortunately, while low sensitivity leads to under-identification of at-risk children, low specificity can lead to over-identification, resulting in inaccurate allocation of limited educational resources. The present study focused on children identified as at-risk in kindergarten who do not subsequently develop poor reading skills to specify factors associated with better reading outcomes among at-risk children. Early screening was conducted in kindergarten and a subset of children was tracked longitudinally until second grade. Potential protective factors were evaluated at cognitive-linguistic, environmental, and neural levels. Relative to at-risk kindergarteners with subsequent poor reading, those with typical reading outcomes were characterized by significantly higher socioeconomic status (SES), speech production accuracy, and structural organization of the posterior right-hemispheric superior longitudinal fasciculus (SLF). A positive association between structural organization of the right SLF and subsequent decoding skills was found to be specific to at-risk children and not observed among typical controls. Among at-risk children, several kindergarten-age factors were found to significantly contribute to the prediction of subsequent decoding skills: white matter organization in the posterior right SLF, age, gender, SES, and phonological awareness. These findings suggest that putative compensatory mechanisms are already present by the start of kindergarten. The right SLF, in conjunction with the cognitive-linguistic and socioeconomic factors identified, may play an important role in facilitating reading development among at-risk children. This study has important implications for approaches to early screening, and assessment strategies for at-risk children.

Thalamus is a common locus of reading, arithmetic, and IQ: Analysis of local intrinsic functional properties

Neuroimaging studies of basic achievement skills - reading and arithmetic - often control for the effect of IQ to identify unique neural correlates of each skill. This may underestimate possible effects of common factors between achievement and IQ measures on neuroimaging results. Here, we simultaneously examined achievement (reading and arithmetic) and IQ measures in young adults, aiming to identify MRI correlates of their common factors. Resting-state fMRI (rs-fMRI) data were analyzed using two metrics assessing local intrinsic functional properties; regional homogeneity (ReHo) and fractional amplitude low frequency fluctuation (fALFF), measuring local intrinsic functional connectivity and intrinsic functional activity, respectively. ReHo highlighted the thalamus/pulvinar (a subcortical region implied for selective attention) as a common locus for both achievement skills and IQ. More specifically, the higher the ReHo values, the lower the achievement and IQ scores. For fALFF, the left superior parietal lobule, part of the dorsal attention network, was positively associated with reading and IQ. Collectively, our results highlight attention-related regions, particularly the thalamus/pulvinar as a key region related to individual differences in performance on all the three measures. ReHo in the thalamus/pulvinar may serve as a tool to examine brain mechanisms underlying a comorbidity of reading and arithmetic difficulties, which could co-occur with weakness in general intellectual abilities.

Functional parcellation of the right cerebellar lobule VI in children with normal or impaired reading

Neuroimaging studies have reported that the right cerebellar lobule VI is engaged in reading, but its role is unclear. The goal of our study was to identify functionally-dissociable subregions in the right lobule VI and how these subregions contribute to reading in children with normal or impaired reading. In Experiment I, typically developing children performed an orthographic task and a phonological task during functional magnetic resonance imaging (fMRI). We classified the voxels in the right lobule VI into seven zones based on the patterns of functional connectivity with the cerebrum across both tasks. In Experiment II, we compared the brain activation and cerebro-cerebellar connectivities of each subregion between children readers with different reading levels. We did not find significant group differences in cerebellar activation. However, we found that impaired readers had considerably higher functional connectivity between R1 and the right angular gyrus and the right precuneus compared to the control group in the phonological task. These findings show that the right cerebellar lobule VI is functionally parceled and its subregions might be differentially connected with the cerebrum between children with normal reading abilities and those with impaired reading.

Neuromagnetic speech discrimination responses are associated with reading-related skills in dyslexic and typical readers

Poor neural speech discrimination has been connected to dyslexia, and may represent phonological processing deficits that are hypothesized to be the main cause for reading impairments. Thus far, neural speech discrimination impairments have rarely been investigated in adult dyslexics, and even less by examining sources of neuromagnetic responses. We compared neuromagnetic speech discrimination in dyslexic and typical readers with mismatch fields (MMF) and determined the associations between MMFs and reading-related skills. We expected weak and atypically lateralized MMFs in dyslexic readers, and positive associations between reading-related skills and MMF strength. MMFs were recorded to a repeating pseudoword /ta-ta/ with occasional changes in vowel identity, duration, or syllable frequency from 43 adults, 21 with confirmed dyslexia. Phonetic (vowel and duration) changes elicited left-lateralized MMFs in the auditory cortices. Contrary to our hypothesis, MMF source strengths or lateralization did not differ between groups. However, better verbal working memory was associated with stronger left-hemispheric MMFs to duration changes across groups, and better reading was associated with stronger right-hemispheric late MMFs across speech-sound changes in dyslexic readers. This suggests a link between neural speech processing and reading-related skills, in line with previous work. Furthermore, our findings suggest a right-hemispheric compensatory mechanism for language processing in dyslexia. The results obtained promote the use of MMFs in investigating reading-related brain processes.

A Review of Online Dyslexia Learning Modules

This paper presents a comprehensive review of publicly available online dyslexia learning modules with a particular focus on the extent to which modules address the prevalent myth that dyslexia is caused by "backwards reading." The authors conducted a systematic internet search to identify publicly available online dyslexia learning modules and coded the content across education, neurocognition, and policy disciplinary domains. We identified 18 topics across a small number (N = 14) of publicly available modules that focused on dyslexia, with only two modules directly addressing this dyslexia myth. While both identified this myth as false, neither provided information about the neurocognitive underpinnings of dyslexia to explain why this myth is false. This review will be useful for guiding further development of online dyslexia learning modules which are urgently needed due to persisting misinformation about this disorder. The coded content reviews of each module will also be beneficial for directing attention to existing resources for professional development on dyslexia.

Putative protective neural mechanisms in prereaders with a family history of dyslexia who subsequently develop typical reading skills

Developmental dyslexia affects 40-60% of children with a familial risk (FHD+) compared to a general prevalence of 5-10%. Despite the increased risk, about half of FHD+ children develop typical reading abilities (FHD+Typical). Yet the underlying neural characteristics of favorable reading outcomes in at-risk children remain unknown. Utilizing a retrospective, longitudinal approach, this study examined whether putative protective neural mechanisms can be observed in FHD+Typical at the prereading stage. Functional and structural brain characteristics were examined in 47 FHD+ prereaders who subsequently developed typical (n = 35) or impaired (n = 12) reading abilities and 34 controls (FHD-Typical). Searchlight-based multivariate pattern analyses identified distinct activation patterns during phonological processing between FHD+Typical and FHD-Typical in right inferior frontal gyrus (RIFG) and left temporo-parietal cortex (LTPC) regions. Follow-up analyses on group-specific classification patterns demonstrated LTPC hypoactivation in FHD+Typical compared to FHD-Typical, suggesting this neural characteristic as an FHD+ phenotype. In contrast, RIFG showed hyperactivation in FHD+Typical than FHD-Typical, and its activation pattern was positively correlated with subsequent reading abilities in FHD+ but not controls (FHD-Typical). RIFG hyperactivation in FHD+Typical was further associated with increased interhemispheric functional and structural connectivity. These results suggest that some protective neural mechanisms are already established in FHD+Typical prereaders supporting their typical reading development.

A Study of Null Effects for the Use of Transcranial Direct Current Stimulation (tDCS) in Adults With and Without Reading Impairment

There is evidence to support the hypothesis that the delivery of anodal transcranial direct current stimulation (tDCS) to the left temporoparietal junction can enhance performance on reading speed and reading accuracy (Costanzo et al., 2016b; Heth & Lavidor, 2015). Here, we explored whether we could demonstrate similar effects in adults with and without reading impairments.

METHOD

Adults with (N = 33) and without (N = 29) reading impairment were randomly assigned to anodal or sham stimulation conditions. All individuals underwent a battery of reading assessments pre and post stimulation. The stimulation session involved 15 min of anodal/sham stimulation over the left temporoparietal junction while concurrently completing a computerized nonword segmentation task known to activate the temporoparietal junction.

RESULTS

There were no conclusive findings that anodal stimulation impacted reading performance for skilled or impaired readers.

CONCLUSIONS

While tDCS may provide useful gains on reading performance in the paediatric population, much more work is needed to establish the parameters under which such findings would transfer to adult populations. The documentation, reporting, and interpreting of null effects of tDCS are immensely important to a field that is growing exponentially with much uncertainty.

Gaze and Motor Traces of Language Processing: Evidence from Autism Spectrum Disorders in Comparison to Typical Controls

We investigated what strategies underlie figurative language processing in two groups of participants distinguished by the presence of a developmental deficit, highly-verbal participants with autism, and control participants without autism in two age ranges each. Individuals with autism spectrum disorder are characterised by impaired social interaction and communication. Even at the high end of the spectrum, where structural language is adequate, difficulties in comprehending non-literal aspects of language are widely attested. The exact causes of these problems are, however, still open to debate. In an interactive sentence-picture matching task participants selected the most suitable image representation of a non-literal figurative expression that matched the target meaning, while their eye-movements and hand movements were being tracked. Our results suggest that individuals with ASD have different processing patterns than typically developing peers when interpreting figurative language, even when they provide the correct answers. Both children with and without autism, and participants with autism display greater uncertainty and competition between alternatives when providing the answer, often reflected in also considering the literal interpretation of the expression against its target figurative meaning. We provide evidence that expression transparency and decomposability play a central role in figurative language processing across all groups.

Remediation of Allophonic Perception and Visual Attention Span in Developmental Dyslexia: A Joint Assay

Categorical perception of phonemes and visual attention span are cognitive processes that contribute independently to poor reading skills in developmental dyslexia. We here explored whether training programs specifically targeting one or the other process do improve reading performance in dyslexic children. The dyslexic participants were trained using either the RapDys© program designed to improve phonemic perception or the MAEVA© program targeting visual attention span. Each participant was provided the two programs successively for intensive training. Results show specific effects of RapDys© on phonemic discrimination and pseudo-word reading. MAEVA© specifically improved visual attention span and irregular word reading. Phonemic awareness and regular word reading improved after application of both training programs, suggesting similar positive effects of both methods although effects of concomitant phonic training cannot be ruled out (as there was no control group). The overall findings suggest that both categorical perception and visual attention span remediation contribute to reading.

Cognitive Neuroscience of Dyslexia

Purpose

This review summarizes what is known about the structural and functional brain bases of dyslexia.

Method

We review the current literature on structural and functional brain differences in dyslexia. This includes evidence about differences in gray matter anatomy, white matter connectivity, and functional activations in response to print and language. We also summarize findings concerning brain plasticity in response to interventions.

Results

We highlight evidence relating brain function and structure to instructional issues such as diagnosis and prognosis. We also highlight evidence about brain differences in early childhood, before formal reading instruction in school, which supports the importance of early identification and intervention.

Conclusion

Neuroimaging studies of dyslexia reveal how the disorder is related to differences in structure and function in multiple neural circuits.

An fMRI-adaptation study of phonological and orthographic selectivity to written words in adults with poor reading skills

Typical readers rely on two brain pathways for word processing in the left hemisphere: temporo-parietal cortex (TPC) and inferior frontal cortex (IFC), thought to subserve phonological decoding, and occipito-temporal cortex (OTC), including the "visual word form area" (VWFA), thought to subserve orthographic processing. How these regions are affected in developmental dyslexia has been a topic of intense research. We employed fMRI rapid adaptation (fMRI-RA) in adults with low reading skills to examine in independently-defined functional regions of interest (ROIs) phonological selectivity to written words in left TPC and IFC, and to orthographic selectivity to written words in OTC. Consistent with the phonological deficit hypothesis of dyslexia, we found responsivity but not selectivity to phonology, as accessed by written words, in the posterior superior temporal gyrus (pSTG) of the TPC. On the other hand, we found orthographic selectivity in the VWFA of the OTC. We also found selectivity to orthographic and not phonological processing in the IFG, a finding previously reported for typical readers. Together our results demonstrate that in adults with poor reading skills, selectivity to phonology is compromised in pSTG, while selectivity to orthography in the VWFA remains unaffected at this level of processing.

Applying microstructural models to understand the role of white matter in cognitive development

Diffusion MRI (dMRI) holds great promise for illuminating the biological changes that underpin cognitive development. The diffusion of water molecules probes the cellular structure of brain tissue, and biophysical modeling of the diffusion signal can be used to make inferences about specific tissue properties that vary over development or predict cognitive performance. However, applying these models to study development requires that the parameters can be reliably estimated given the constraints of data collection with children. Here we collect repeated scans using a typical multi-shell diffusion MRI protocol in a group of children (ages 7-12) and use two popular modeling techniques to examine individual differences in white matter structure. We first assess scan-rescan reliability of model parameters and show that axon water faction can be reliably estimated from a relatively fast acquisition, without applying spatial smoothing or de-noising. We then investigate developmental changes in the white matter, and individual differences that correlate with reading skill. Specifically, we test the hypothesis that previously reported correlations between reading skill and diffusion anisotropy in the corpus callosum reflect increased axon water fraction in poor readers. Both models support this interpretation, highlighting the utility of these approaches for testing specific hypotheses about cognitive development.

Oculomotor and Inhibitory Control in Dyslexia

Previous research has suggested that people with dyslexia may have an impairment of inhibitory control. The oculomotor system is vulnerable to interference at various levels of the system, from high level cognitive control to peripheral neural pathways. Therefore, in this work we examined two forms of oculomotor inhibition and two forms of oculomotor interference at high and low levels of the control system. This study employed a prosaccade, antisaccade, and a recent distractor eye movement task (akin to a spatial negative priming) in order to explore high level cognitive control and the inhibition of a competing distractor. To explore low-level control we examined the frequency of microsaccades and post-saccade oscillations. The findings demonstrated that dyslexics have an impairment of volitional inhibitory control, reflected in the antisaccade task. In contrast, inhibitory control at the location of a competing distractor was equivalent in the dyslexic and non-dyslexic groups. There was no difference in the frequency of microsaccades between the two groups. However, the dyslexic group generated larger microsaccades prior to the target onset in the prosaccade and the antisaccade tasks.The groups did not differ in the frequency or in the morphology of the post-saccade oscillations. These findings reveal that the word reading and attentional difficulties of dyslexic readers cannot be attributed to an impairment in the inhibition of a visual distractor or interference from low-level oculomotor instability. We propose that the inhibitory impairment in dyslexia occurs at a higher cognitive level, perhaps in relation to the process of attentional disengagement.

Brain Mechanisms Underlying Visuo-Orthographic Deficits in Children With Developmental Dyslexia

Multiple hypotheses have been proposed to explain the reading difficulty caused by developmental dyslexia (DD). The current study examined visuo-orthographic processing in children with dyslexia to determine whether orthographic deficits are explainable based solely on visual deficits. To identify orthographic-specific, visual perception-specific, and overlapping deficits, we included two tasks (lexical and perceptual) in three Chinese subject groups: children with DD, age-matched controls (AC), and reading matched controls (RC) using functional magnetic resonance imaging (fMRI). We found that the left precuneus showed decreased activation across both tasks for the DD group compared to the two control groups, thus reflecting visual processing deficits in children with DD, which also affects orthographic processing. Furthermore, we found that the functional connectivity between left middle occipital gyrus (LMOG) and left inferior frontal gyrus (IFG) was decreased in the DD group compared to AC and RC for only the lexical task. This suggests a weaker association between orthography and phonology for children with DD. In addition, the children with DD showed decreased functional connectivity between the LMOG and right parahippocampal gyrus for only the visual perceptual task, thereby indicating a weaker association between visual regions for DD during visual symbol processing. Taken together, our findings suggest that the observed orthographic processing deficit in DD might be driven by both a basic visual deficit, and a linguistic deficit.

Neonatal brain injury causes cerebellar learning deficits and Purkinje cell dysfunction

Premature infants are more likely to develop locomotor disorders than term infants. In a chronic sub-lethal hypoxia (Hx) mouse model of neonatal brain injury, we recently demonstrated the presence of cellular and physiological changes in the cerebellar white matter. We also observed Hx-induced delay in Purkinje cell (PC) arborization. However, the behavioral consequences of these cellular alterations remain unexplored. Using the Erasmus Ladder to study cerebellar behavior, we report the presence of locomotor malperformance and long-term cerebellar learning deficits in Hx mice. Optogenetics experiments in Hx mice reveal a profound reduction in spontaneous and photoevoked PC firing frequency. Finally, treatment with a gamma-aminobutyric acid (GABA) reuptake inhibitor partially rescues locomotor performance and improves PC firing. Our results demonstrate a long-term miscoordination phenotype characterized by locomotor malperformance and cerebellar learning deficits in a mouse model of neonatal brain injury. Our findings also implicate the developing GABA network as a potential therapeutic target for prematurity-related locomotor deficits.

Neural correlates of phonological, orthographic and semantic reading processing in dyslexia

Developmental dyslexia is one of the most prevalent learning disabilities, thought to be associated with dysfunction in the neural systems underlying typical reading acquisition. Neuroimaging research has shown that readers with dyslexia exhibit regional hypoactivation in left hemisphere reading nodes, relative to control counterparts. This evidence, however, comes from studies that have focused only on isolated aspects of reading. The present study aims to characterize left hemisphere regional hypoactivation in readers with dyslexia for the main processes involved in successful reading: phonological, orthographic and semantic. Forty-one participants performed a demanding reading task during MRI scanning. Results showed that readers with dyslexia exhibited hypoactivation associated with phonological processing in parietal regions; with orthographic processing in parietal regions, Broca's area, ventral occipitotemporal cortex and thalamus; and with semantic processing in angular gyrus and hippocampus. Stronger functional connectivity was observed for readers with dyslexia than for control readers 1) between the thalamus and the inferior parietal cortex/ventral occipitotemporal cortex during pseudoword reading; and, 2) between the hippocampus and the pars opercularis during word reading. These findings constitute the strongest evidence to date for the interplay between regional hypoactivation and functional connectivity in the main processes supporting reading in dyslexia.

tDCS Modulatory Effect on Reading Processes: A Review of Studies on Typical Readers and Individuals With Dyslexia

The possibility to use non-invasive brain stimulation to modulate reading performance in individuals with developmental dyslexia (DD) has been recently explored by few empirical investigations. The present systematic review includes nine studies which have employed transcranial direct current stimulation (tDCS) aiming at improving reading abilities in both typical readers and individuals with DD. Anodal tDCS over the left temporo-parietal cortex—a region which is typically involved in phonological and orthographic processing during reading tasks and underactive in individuals with DD—was the most frequently used montage. The majority of studies employing such stimulation protocol showed significant improvement in differential reading subprocesses. More precisely, word decoding was improved in adult readers, whereas non-word and low-frequency word reading in younger individuals. Furthermore, tDCS was found to be specifically effective in poor readers and individuals with DD rather than typical readers, in spite of the specific brain region targeted by the stimulation; Left frontal, left temporo-parietal, and right cerebellar tDCS failed to modulate reading in already proficient readers. Overall, tDCS appears to be a promising remedial tool for reading difficulties, even when applied to younger populations with reading problems. Further empirical evidence is needed to confirm the potential of neuromodulation as a successful intervention method for DD.

Effect of reading intervention and task difficulty on orthographic and phonological reading systems in the brain

Children with poor reading skills have differences in brain function when compared to typically-developing readers, and there may also be changes in the brain following reading intervention. However, most functional imaging studies focus on phonological reading tasks with one level of task difficulty. The purpose of this study was to compare good and poor readers on functional magnetic resonance imaging (fMRI) tasks of orthography (spelling) and phonology (rhyming) before and after 3 months of school-based intervention. These tasks were also modulated by task difficulty based on printed word frequency. The results showed that primarily left hemisphere regions were activated for the spelling and rhyming tasks, and poor readers showed a pattern of increased activation in bilateral inferior frontal, bilateral insula, right parietal, and left cerebellum following intervention. Activity in left pars triangularis and right parietal regions were associated with gains in decoding skills. Intervention effects appeared across blocks of easy and difficult words, except for the right parietal cortex. In this region, poor readers had greater activity on the easy word blocks after intervention, which indicates that there was increased recruitment of the right parietal cortex for relatively easy words. These results indicate that effects of intervention may be more evident on phonological tasks in comparison to orthographic tasks, and some of these effects may be modulated by relative task difficulty.

Rapid and widespread white matter plasticity during an intensive reading intervention

White matter tissue properties are known to correlate with performance across domains ranging from reading to math, to executive function. Here, we use a longitudinal intervention design to examine experience-dependent growth in reading skills and white matter in grade school-aged, struggling readers. Diffusion MRI data were collected at regular intervals during an 8-week, intensive reading intervention. These measurements reveal large-scale changes throughout a collection of white matter tracts, in concert with growth in reading skill. Additionally, we identify tracts whose properties predict reading skill but remain fixed throughout the intervention, suggesting that some anatomical properties stably predict the ease with which a child learns to read, while others dynamically reflect the effects of experience. These results underscore the importance of considering recent experience when interpreting cross-sectional anatomy–behavior correlations. Widespread changes throughout the white matter may be a hallmark of rapid plasticity associated with an intensive learning experience.

White matter properties correlate with cognitive performance in a number of domains. Here the authors show that altering a child’s educational environment though a targeted intervention program induces rapid, large-scale changes in the white matter, and that these changes track the learning process.

What's in a name? Perspectives of dyslexia assessors working with students in the UK higher education sector

Research findings and positions concerning the nature of the dyslexia construct are currently diverse and increasingly complex. The ability of assessor practitioners to operationalize such knowledge and categorically diagnose dyslexia in any reliable and consistent way is being questioned. This study aimed to explore the way in which diverse and complex research findings are operationalized in the dyslexia diagnostic assessment of UK higher education students. The perspectives of 118 professional assessors of dyslexia working within the sector were collected using a questionnaire and some interviews. Data were analysed both quantitatively and qualitatively, as appropriate, and then integrated. The results confirmed critics' concerns about the consistency and reliability of the construct as currently diagnosed within the higher education context. Key controversial aspects of practice that emerged included the contextualized interpretation of literacy difficulties, a general commitment to discrepancy concepts, scepticism about the face validity of prescribed psychometric tests, and a related reliance on professional observation and experience above test results. The findings pointed to the need for a more informed nuanced understanding of the dyslexia label and a more cautious and responsible attitude towards its use.

Prefrontal mediation of the reading network predicts intervention response in dyslexia

A primary challenge facing the development of interventions for dyslexia is identifying effective predictors of intervention response. While behavioral literature has identified core cognitive characteristics of response, the distinction of reading versus executive cognitive contributions to response profiles remains unclear, due in part to the difficulty of segregating these constructs using behavioral outputs. In the current study we used functional neuroimaging to piece apart the mechanisms of how/whether executive and reading network relationships are predictive of intervention response. We found that readers who are responsive to intervention have more typical pre-intervention functional interactions between executive and reading systems compared to nonresponsive readers. These findings suggest that intervention response in dyslexia is influenced not only by domain-specific reading regions, but also by contributions from intervening domain-general networks. Our results make a significant gain in identifying predictive bio-markers of outcomes in dyslexia, and have important implications for the development of personalized clinical interventions.

Parietotemporal Stimulation Affects Acquisition of Novel Grapheme-Phoneme Mappings in Adult Readers

Neuroimaging work from developmental and reading intervention research has suggested a cause of reading failure may be lack of engagement of parietotemporal cortex during initial acquisition of grapheme-phoneme (letter-sound) mappings. Parietotemporal activation increases following grapheme-phoneme learning and successful reading intervention. Further, stimulation of parietotemporal cortex improves reading skill in lower ability adults. However, it is unclear whether these improvements following stimulation are due to enhanced grapheme-phoneme mapping abilities. To test this hypothesis, we used transcranial direct current stimulation (tDCS) to manipulate parietotemporal function in adult readers as they learned a novel artificial orthography with new grapheme-phoneme mappings. Participants received real or sham stimulation to the left inferior parietal lobe (L IPL) for 20 min before training. They received explicit training over the course of 3 days on 10 novel words each day. Learning of the artificial orthography was assessed at a pre-training baseline session, the end of each of the three training sessions, an immediate post-training session and a delayed post-training session about 4 weeks after training. Stimulation interacted with baseline reading skill to affect learning of trained words and transfer to untrained words. Lower skill readers showed better acquisition, whereas higher skill readers showed worse acquisition, when training was paired with real stimulation, as compared to readers who received sham stimulation. However, readers of all skill levels showed better maintenance of trained material following parietotemporal stimulation, indicating a differential effect of stimulation on initial learning and consolidation. Overall, these results indicate that parietotemporal stimulation can enhance learning of new grapheme-phoneme relationships in readers with lower reading skill. Yet, while parietotemporal function is critical to new learning, its role in continued reading improvement likely changes as readers progress in skill.

Auditory temporal perceptual learning and transfer in Chinese-speaking children with developmental dyslexia

Perceptual learning refers to the improvement of perceptual performance as a function of training. Recent studies found that auditory perceptual learning may improve phonological skills in individuals with developmental dyslexia in alphabetic writing system. However, whether auditory perceptual learning could also benefit the reading skills of those learning the Chinese logographic writing system is, as yet, unknown. The current study aimed to investigate the remediation effect of auditory temporal perceptual learning on Mandarin-speaking school children with developmental dyslexia. Thirty children with dyslexia were screened from a large pool of students in 3th-5th grades. They completed a series of pretests and then were assigned to either a non-training control group or a training group. The training group worked on a pure tone duration discrimination task for 7 sessions over 2 weeks with thirty minutes per session. Post-tests immediately after training and a follow-up test 2 months later were conducted. Analyses revealed a significant training effect in the training group relative to non-training group, as well as near transfer to the temporal interval discrimination task and far transfer to phonological awareness, character recognition and reading fluency. Importantly, the training effect and all the transfer effects were stable at the 2-month follow-up session. Further analyses found that a significant correlation between character recognition performance and learning rate mainly existed in the slow learning phase, the consolidation stage of perceptual learning, and this effect was modulated by an individuals' executive function. These findings indicate that adaptive auditory temporal perceptual learning can lead to learning and transfer effects on reading performance, and shed further light on the potential role of basic perceptual learning in the remediation and prevention of developmental dyslexia.

Reading skill-fractional anisotropy relationships in visuospatial tracts diverge depending on socioeconomic status

Low socioeconomic status (SES) has been repeatedly linked with decreased academic achievement, including lower reading outcomes. Some lower SES children do show skills and scores commensurate with those of their higher SES peers, but whether their abilities stem from the same systems as high SES children or are based on divergent strategies is unknown. We here investigated a potential interactive relationship between SES and real-word reading skill in the white matter in 42 typically developing children. SES was determined based on parental education; reading skill and age were not significantly related to SES. There was a significant neural interaction: Clusters in the bilateral inferior longitudinal fasciculus (ILF), left superior longitudinal fasciculus, and left corticospinal tract demonstrated interactive skill-SES relationships in fractional anisotropy. Follow-up analyses demonstrated that higher SES children showed a positive relationship between fractional anisotropy, reflecting tract coherence, and reading skill in left hemisphere tract clusters, whereas lower SES children showed a positive relationship in the right hemisphere homologues. Broadly, the ILF has been demonstrated to support orthographic skill on the left and more general visuospatial processing on the right, so high reading achievement in lower SES children may rely on supplementary visuospatial processing more than for higher SES readers. This pattern is consistent with previous work reporting low SES children's environments to include less rich verbal experience, which may lead them to disproportionately draw on visuospatial skills for success. Further, these results indicate that group SES differences may be best described by an adaptive, not a deficit, model.

Elaborative feedback: Engaging reward and task-relevant brain regions promotes learning in pseudoword reading aloud

Although much is known about the cognitive and neural basis of establishing letter-sound mappings in learning word forms, relatively little is known about what makes for the most effective feedback during this process. We sought to determine the neural basis by which elaborative feedback (EF), which contains both reward-related and content-specific information, may be more helpful than feedback containing only one kind of information (simple positive feedback, PF) or the other (content feedback, CF) in learning orthography-phonology (spelling-sound) mappings for novel letter strings. Compared to CF, EF activated the ventromedial prefrontal cortex, implicated in reward processing. Compared to PF, EF activated the posterior middle temporal, superior temporal, and supramarginal gyri-regions implicated in orthography-phonology conversion. In the same comparison, EF also activated the left fusiform gyrus/visual word form area-implicated in orthographic processing. Also EF, but not CF or PF, modulated activity in the caudate nucleus. In a postscan questionnaire, EF and PF were rated as more pleasant than CF, suggesting that modulation of the caudate for EF may be due to the coupling of reward and skill content. These findings suggest the enhanced effectiveness of EF may be due to concurrent activation of reward-related and task-relevant brain regions.

Changes in intrinsic local connectivity after reading intervention in children with autism

Most of the existing behavioral and cognitive intervention programs in autism spectrum disorders (ASD) have not been tested at the neurobiological level, thus falling short of finding quantifiable neurobiological changes underlying behavioral improvement. The current study takes a translational neuroimaging approach to test the impact of a structured visual imagery-based reading intervention on improving reading comprehension and assessing its underlying local neural circuitry. Behavioral and resting state functional MRI (rs-fMRI) data were collected from children with ASD who were randomly assigned to an Experimental group (ASD-EXP; n=14) and a Wait-list control group (ASD-WLC; n=14). Participants went through an established reading intervention training program (Visualizing and Verbalizing for language comprehension and thinking or V/V; 4-h per day, 10-weeks, 200h of face-to-face instruction). Local functional connectivity was examined using a connection density approach from graph theory focusing on brain areas considered part of the Reading Network. The main results are as follows: (I) the ASD-EXP group showed significant improvement, compared to the ASD-WLC group, in their reading comprehension ability evidenced from change in comprehension scores; (II) the ASD-EXP group showed increased local brain connectivity in Reading Network regions compared to the ASD-WLC group post-intervention; (III) intervention-related changes in local brain connectivity were observed in the ASD-EXP from pre to post-intervention; and (IV) improvement in language comprehension significantly predicted changes in local connectivity. The findings of this study provide novel insights into brain plasticity in children with developmental disorders using targeted intervention programs.

Specific effects of working memory training on the reading skills of Chinese children with developmental dyslexia

Most research on working memory (WM) training for children with developmental dyslexia (DD) has focused on western alphabetical languages. Moreover, most of these studies used a combination of training tasks targeting a variety of WM components, making it difficult to determine whether WM training generates a general improvement in overall reading, or improves specific cognitive skills corresponding to the WM components that are targeted in training. We tested the general and specific effects of WM training on the reading skills of 45 Chinese children with DD, grades 3 to 5. In Experiment 1, the experimental group received a program targeting the verbal WM component; in Experiment 2, the experimental group was trained with a program targeting visuospatial WM. In both experiments the control group played a placebo video game. In Experiment 1, the experimental group outperformed the control group on the visual rhyming task, which is highly correlated with verbal WM. In Experiment 2, the experimental group outperformed the control group on the orthographic awareness test, which is highly correlated with visuospatial WM. Furthermore, in both Experiment 1 and Experiment 2, the experimental groups outperformed the control groups on the fast word naming test, which is highly related to both visuospatial WM and verbal WM. Results indicated that WM training improved specific reading-related cognitive skills that are highly correlated with the specific WM components that were the target of training.

Common Brain Structure Findings Across Children with Varied Reading Disability Profiles

Dyslexia is a developmental disorder in reading that exhibits varied patterns of expression across children. Here we examined the degree to which different kinds of reading disabilities (defined as profiles or patterns of reading problems) contribute to brain morphology results in Jacobian determinant images that represent local brain shape and volume. A matched-pair brain morphometry approach was used to control for confounding from brain size and research site effects in this retrospective multi-site study of 134 children from eight different research sites. Parietal operculum, corona radiata, and internal capsule differences between cases and controls were consistently observed across children with evidence of classic dyslexia, specific comprehension deficit, and language learning disability. Thus, there can be common brain morphology findings across children with quite varied reading disability profiles that we hypothesize compound the developmental difficulties of children with unique reading disability profiles and reasons for their reading disability.

Neurobiological bases of reading disorder Part I: Etiological investigations

While many studies have focused on identifying the neural and behavioral characteristics of decoding-based reading disorder (RD, aka developmental dyslexia), the etiology of RD remains largely unknown and understudied. Because the brain plays an intermediate role between genetic factors and behavioral outcomes, it is promising to address causality from a neural perspective. In the current, Part I of the two-part review, we discuss neuroimaging approaches to addressing the causality issue and review the results of studies that have employed these approaches. We assume that if a neural signature were associated with RD etiology, it would (a) manifest across comparisons in different languages, (b) be experience independent and appear in comparisons between RD and reading-matched controls, (c) be present both pre- and post-intervention, (d) be found in at-risk, pre-reading children and (e) be associated with genetic risk. We discuss each of these five characteristics in turn and summarize the studies that have examined each of them. The available literature provides evidence that anomalies in left temporo-parietal cortex, and possibly occipito-temporal cortex, may be closely related to the etiology of RD. Improved understanding of the etiology of RD can help improve the accuracy of early detection and enable targeted intervention of cognitive processes that are amenable to change, leading to improved outcomes in at-risk or affected populations.

The implications for education of an innate numerosity-processing mechanism

One specific cause of low numeracy is a deficit in a mechanism for representing and processing numerosities that humans inherited and which is putatively shared with many other species. This deficit is evident at each of the four levels of explanation in the 'causal modelling' framework of Morton and Frith (Morton and Frith 1995 In Manual of developmental psychopathology, vol. 1 (eds D Cichetti, D Cohen), pp. 357-390). Very low numeracy can occur in cognitively able individuals with normal access to good education: it is linked to an easily measured deficit in basic numerosity processing; it has a distinctive neural signature; and twin studies suggest specific heritability, though the relevant genes have not yet been identified. Unfortunately, educators and policymakers seem largely unaware of this cause, but appropriate interventions could alleviate the suffering and handicap of those with low numeracy, and would be a major benefit to society.This article is part of a discussion meeting issue 'The origins of numerical abilities'.