Core deficit and individual manifestations of developmental dyscalculia (DD): The role of comorbidity

Neurocognitive mechanisms of co-occurring math difficulties in dyslexia: Differences in executive function and visuospatial processing

Children with dyslexia frequently also struggle with math. However, studies of reading disability (RD) rarely assess math skill, and the neurocognitive mechanisms underlying co-occurring reading and math disability (RD+MD) are not clear. The current study aimed to identify behavioral and neurocognitive factors associated with co-occurring MD among 86 children with RD. Within this sample, 43% had co-occurring RD+MD and 22% demonstrated a possible vulnerability in math, while 35% had no math difficulties (RD-Only). We investigated whether RD-Only and RD+MD students differed behaviorally in their phonological awareness, reading skills, or executive functions, as well as in the brain mechanisms underlying word reading and visuospatial working memory using functional magnetic resonance imaging (fMRI). The RD+MD group did not differ from RD-Only on behavioral or brain measures of phonological awareness related to speech or print. However, the RD+MD group demonstrated significantly worse working memory and processing speed performance than the RD-Only group. The RD+MD group also exhibited reduced brain activations for visuospatial working memory relative to RD-Only. Exploratory brain-behavior correlations along a broad spectrum of math ability revealed that stronger math skills were associated with greater activation in bilateral visual cortex. These converging neuro-behavioral findings suggest that poor executive functions in general, including differences in visuospatial working memory, are specifically associated with co-occurring MD in the context of RD. RESEARCH HIGHLIGHTS: Children with reading disabilities (RD) frequently have a co-occurring math disability (MD), but the mechanisms behind this high comorbidity are not well understood. We examined differences in phonological awareness, reading skills, and executive function between children with RD only versus co-occurring RD+MD using behavioral and fMRI measures. Children with RD only versus RD+MD did not differ in their phonological processing, either behaviorally or in the brain. RD+MD was associated with additional behavioral difficulties in working memory, and reduced visual cortex activation during a visuospatial working memory task.

Anatomical connectivity in children with developmental dyscalculia: A graph theory study

Current theories postulate that numerical processing depends upon a brain circuit formed by regions and their connections; specialized in the representation and manipulation of the numerical properties of stimuli. It has been suggested that the damage of these network may cause Developmental Dyscalculia (DD): a persistent neurodevelopmental disorder that significantly interferes with academic performance and daily life activities that require mastery of mathematical notions and operations. However, most of the studies on the brain foundations of DD have focused on regions of interest associated with numerical processing, and have not addressed numerical cognition as a complex network phenomenon. The present study explored DD using a Graph Theory network approach. We studied the association between topological measures of integration and segregation of information processing in the brain proposed by Graph Theory; and individual variability in numerical performance in a group of 11 school-aged children with DD (5 of which presented with comorbidity with Developmental Dyslexia, the specific learning disorder for reading) and 17 typically developing peers. A statistically significant correlation was found between the Weber fraction (a measure of numerical representations' precision) and the Clustering Index (a measure of segregation of information processing) in the whole sample. The DD group showed significantly lower Characteristic Path Length (average shortest path length among all pairs of regions in the brain network) compared to controls. Also, differences in critical regions for the brain network performance (hubs) were found between groups. The presence of limbic hubs characterized the DD brain network while right Temporal and Frontal hubs found in controls were absent in the DD group. Our results suggest that the DD may be associated with alterations in anatomical brain connectivity that hinder the capacity to integrate and segregate numerical information.

Telerehabilitation Pathways in Specific Learning Disorders: Improving Reading and Writing

Telerehabilitation has proved to be a useful tool for neurodevelopmental disorders in allowing timely and intensive intervention and preventing relapses; it is also widely used for specific learning disabilities (SLD), showing significant effects on reading abilities, but variables linked to its effectiveness have not been studied yet. The present study was aimed at testing the effectiveness of telerehabilitation on reading and writing in SLD children, comparing different treatment pathways, and considering the impact of training intensity and executive functions. Seventy-three children were enrolled (telerehabilitation group: 48 children, waiting list group: 25 children). The results showed significant improvements in reading fluency, text dictation, and executive functions in the training group. Children attending a combined training including reading tasks and rapid automatized naming processes improved in word reading fluency and text dictation. The number of training sessions and the change in executive functions significantly correlated with changes in reading accuracy. Here we show a new contribution to telerehabilitation research in SLD: telerehabilitation significantly enhanced learning abilities and executive functions. Training based on the learning task and the underlying processes significantly increased not only reading speed, according to previous studies, but also writing accuracy. The findings’ implications in clinical research and practice are discussed.

Dysfunctions associated with the intraparietal sulcus and a distributed network in individuals with math learning difficulties: An ALE meta-analysis

Math learning difficulty (MLD) is a learning disorder characterized by persistent impairments in the understanding and application of numbers independent of intelligence or schooling. The current study aims to review existing neuroimaging studies to characterize the neurobiological basis in MLD for their quantity and arithmetic dysfunctions. We identified a total of 24 studies with 728 participants through the literature. Using the activation likelihood estimate (ALE) method, we found that the most consistent neurobiological dysfunction in MLD was observed in the right intraparietal sulcus (IPS) with distinct patterns of the anterior and posterior aspects. Meanwhile, neurobiological dysfunctions were also observed in a distributed network including the fusiform gyrus, inferior temporal gyrus, insula, prefrontal cortex, anterior cingulate cortex, and claustrum. Our results suggest a core dysfunction in the right anterior IPS and left fusiform gyrus with atypically upregulated functions in brain regions for attention, working memory, visual processing, and motivation, serving as the neurobiological basis of MLD.

Foundational Number Sense Training Gains Are Predicted by Hippocampal-Parietal Circuits

The development of mathematical skills in early childhood relies on number sense, the foundational ability to discriminate among quantities. Number sense in early childhood is predictive of academic and professional success, and deficits in number sense are thought to underlie lifelong impairments in mathematical abilities. Despite its importance, the brain circuit mechanisms that support number sense learning remain poorly understood. Here, we designed a theoretically motivated training program to determine brain circuit mechanisms underlying foundational number sense learning in female and male elementary school-age children (7-10 years). Our 4 week integrative number sense training program gradually strengthened the understanding of the relations between symbolic (Arabic numerals) and nonsymbolic (sets of items) representations of quantity. We found that our number sense training program improved symbolic quantity discrimination ability in children across a wide range of math abilities including children with learning difficulties. Crucially, the strength of pretraining functional connectivity between the hippocampus and intraparietal sulcus, brain regions implicated in associative learning and quantity discrimination, respectively, predicted individual differences in number sense learning across typically developing children and children with learning difficulties. Reverse meta-analysis of interregional coactivations across 14,371 fMRI studies and 89 cognitive functions confirmed a reliable role for hippocampal-intraparietal sulcus circuits in learning. Our study identifies a canonical hippocampal-parietal circuit for learning that plays a foundational role in children's cognitive skill acquisition. Findings provide important insights into neurobiological circuit markers of individual differences in children's learning and delineate a robust target for effective cognitive interventions.SIGNIFICANCE STATEMENT Mathematical skill development relies on number sense, the ability to discriminate among quantities. Here, we develop a theoretically motivated training program and investigate brain circuits that predict number sense learning in children during a period important for acquisition of foundational cognitive skills. Our integrated number sense training program was effective in children across a wide a range of math abilities, including children with learning difficulties. We identify hippocampal-parietal circuits that predict individual differences in learning gains. Our study identifies a brain circuit critical for the acquisition of foundational cognitive skills, which will be useful for developing effective interventions to remediate learning disabilities.

The cognitive profiles for different samples of mathematical learning difficulties and their similarity to typical development: Evidence from a longitudinal study

Several cognitive deficits have been suggested to induce mathematical learning difficulties (MLD), but it is unclear whether the cognitive profile for all children with MLD is the same and to what extent it differs from typically developing (TD) children. This study investigated whether such a profile could be distinguished when cognitive skills and math performance are compared between TD children and children with MLD. This was accomplished by employing two-way repeated-measures analyses of covariance in 276 10-year-old participants (60 with MLD) from fourth and fifth grades. In addition, we investigated whether more restrictive selection criteria for MLD result in different mathematical and cognitive profiles by means of independent-samples t tests. Results revealed that cognitive mechanisms for math development are mostly similar for children with MLD and TD children and that variability in sample selection criteria did not produce different mathematical or cognitive profiles. To conclude, the cognitive mechanisms for math development are broadly similar for children with MLD and their TD counterparts even when different MLD samples were selected. This strengthens our idea that MLD can be defined as the worst performance on a continuous scale rather than as a discrete disorder.

The co-occurrence of Attention-Deficit/Hyperactivity Disorder and mathematical difficulties: An investigation of the role of basic numerical skills

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) and dyscalculia, also called mathematics disorder, frequently co-occur, yet the etiology of this comorbidity is poorly understood.

AIMS

This study investigated whether impairments in the understanding of numbers and magnitudes (basic numerical skills) are a unique risk factor for mathematical difficulties (MD) or a shared risk factor that could help to explain the association between ADHD and MD.

METHODS AND PROCEDURES

Basic numerical skills were assessed with eight subtests in children (age 6-10 years, N = 86) with clinically significant ADHD symptoms and/or MD and typically developing children (control group). This double dissociation design allowed to test for main and interaction effects of ADHD and MD using both classical and Bayesian analysis of variance (ANOVA).

OUTCOMES AND RESULTS

Children with MD were impaired in transcoding, complex number and magnitude comparison, and arithmetic fact retrieval. They were not impaired in tasks assessing core markers of numeracy, which might be explained by the sample including children with mathematical difficulties instead of a diagnosed dyscalculia. ADHD was not associated with deficits in any of the tasks. The evidence for an additive combination of cognitive profiles was weak.

CONCLUSIONS AND IMPLICATIONS

Impairments in basic numerical skills are uniquely associated with MD and do not represent a shared risk factor for ADHD symptoms and MD.

Understanding comorbidity of learning disorders: task-dependent estimates of prevalence

BACKGROUND

Reading disorder (RD) and mathematics disorder (MD) frequently co-occur. However, the exact comorbidity rates differ largely between studies. Given that MD is characterised by high heterogeneity on the symptom level, differences in comorbidity rates may result from different mathematical subskills used to define MD. Comorbidity rates with RD are likely to be higher when MD is measured by mathematical subskills that do not only build on number processing, but also require language (i.e. arithmetic fluency), than when measured by magnitude processing skills.

METHODS

The association between literacy, arithmetic fluency and magnitude processing as well as the overlap between deficits in these domains were assessed in a representative sample of 1,454 third Graders.

RESULTS

Associations were significantly higher between literacy and arithmetic, than between literacy and magnitude processing. This was also reflected in comorbidity rates: comorbidity rates between literacy and arithmetic deficits were four times higher than expected by chance, whereas comorbidity rates between literacy and magnitude processing deficits did not exceed chance rate. Deficits in the two mathematical subskills showed some overlap, but also revealed dissociations, corroborating the high heterogeneity of MD. Results are interpreted within a multiple-deficit framework and implications for diagnosis and intervention are discussed.

CONCLUSIONS

The overlap between RD and MD depends on the subskills used to define MD. Due to shared domain-general factors mathematical subskills that draw on language skills are more strongly associated with literacy than those that do not require language. The findings further indicate that the same symptom, such as deficits in arithmetic, can be associated with different cognitive deficits, a deficit in language skills or a deficit in number processing.

Dyscalculia and Typical Math Achievement Are Associated With Individual Differences in Number-Specific Executive Function

Deficits in numerical magnitude perception characterize the mathematics learning disability developmental dyscalculia (DD), but recent studies suggest the relation stems from inhibitory control demands from incongruent visual cues in the nonsymbolic number comparison task. This study investigated the relation among magnitude perception during differing congruency conditions, executive function, and mathematics achievement measured longitudinally in children (n = 448) from ages 4 to 13. This relation was investigated across achievement groups and as it related to mathematics across the full range of achievement. Only performance on incongruent trials related to achievement. Findings indicate that executive function in a numerical context, beyond magnitude perception or executive function in a non-numerical context, relates to DD and mathematics across a wide range of achievement.

Analyzing Global Components in Developmental Dyscalculia and Dyslexia

The study examined whether developmental deficits in reading and numerical skills could be expressed in terms of global factors by reference to the rate and amount (RAM) and difference engine (DEM) models. From a sample of 325 fifth grade children, we identified 5 children with dyslexia, 16 with dyscalculia, 7 with a “mixed pattern,” and 49 control children. Children were asked to read aloud words presented individually that varied for frequency and length and to respond (either vocally or manually) to a series of simple number tasks (addition, subtraction, number reading, and number comparisons). Reaction times were measured. Results indicated that the deficit of children with dyscalculia and children with a mixed pattern on numerical tasks could be explained by a single global factor, similarly to the reading deficit shown by children with dyslexia. As predicted by the DEM, increases in task difficulty were accompanied by a corresponding increase in inter-individual variability for both the reading and numerical tasks. These relationships were constant across the four groups of children but differed in terms of slope and intercept on the x-axis, indicating that two different general rules underlie performance in reading and numerical skills. The study shows for the first time that, as previously shown for reading, also numerical performance can be explained with reference to a global factor. The advantage of this approach is that it takes into account the over-additivity effect, i.e., the presence of larger group differences in the case of more difficult conditions over and above the characteristics of the experimental conditions. It is concluded that reference to models such as the RAM and DEM can be useful in delineating the characteristics of the dyscalculic deficit as well as in the description of co-morbid disturbances, as in the case of dyslexia and dyscalculia.

Numerical magnitude processing deficits in children with mathematical difficulties are independent of intelligence

Developmental dyscalculia (DD) is thought to arise from difficulties in the ability to process numerical magnitudes. Most research relied on IQ-discrepancy based definitions of DD and only included individuals with normal IQ, yet little is known about the role of intelligence in the association between numerical magnitude processing and mathematical difficulties (MD). The present study examined numerical magnitude processing in matched groups of 7- to 8-year-olds (n=42) who had either discrepant MD (poor math scores, average IQ), nondiscrepant MD (poor math scores, below-average IQ) or no MD. Both groups of children with MD showed similar impairments in numerical magnitudes processing compared to controls, suggesting that the association between numerical magnitude processing deficits and MD is independent of intelligence.

Specific learning disorder: prevalence and gender differences

Comprehensive models of learning disorders have to consider both isolated learning disorders that affect one learning domain only, as well as comorbidity between learning disorders. However, empirical evidence on comorbidity rates including all three learning disorders as defined by DSM-5 (deficits in reading, writing, and mathematics) is scarce. The current study assessed prevalence rates and gender ratios for isolated as well as comorbid learning disorders in a representative sample of 1633 German speaking children in 3rd and 4th Grade. Prevalence rates were analysed for isolated as well as combined learning disorders and for different deficit criteria, including a criterion for normal performance. Comorbid learning disorders occurred as frequently as isolated learning disorders, even when stricter cutoff criteria were applied. The relative proportion of isolated and combined disorders did not change when including a criterion for normal performance. Reading and spelling deficits differed with respect to their association with arithmetic problems: Deficits in arithmetic co-occurred more often with deficits in spelling than with deficits in reading. In addition, comorbidity rates for arithmetic and reading decreased when applying stricter deficit criteria, but stayed high for arithmetic and spelling irrespective of the chosen deficit criterion. These findings suggest that the processes underlying the relationship between arithmetic and reading might differ from those underlying the relationship between arithmetic and spelling. With respect to gender ratios, more boys than girls showed spelling deficits, while more girls were impaired in arithmetic. No gender differences were observed for isolated reading problems and for the combination of all three learning disorders. Implications of these findings for assessment and intervention of learning disorders are discussed.

Residual number processing in dyscalculia

Developmental dyscalculia – a congenital learning disability in understanding numerical concepts – is typically associated with parietal lobe abnormality. However, people with dyscalculia often retain some residual numerical abilities, reported in studies that otherwise focused on abnormalities in the dyscalculic brain. Here we took a different perspective by focusing on brain regions that support residual number processing in dyscalculia. All participants accurately performed semantic and categorical colour-decision tasks with numerical and non-numerical stimuli, with adults with dyscalculia performing slower than controls in the number semantic tasks only. Structural imaging showed less grey-matter volume in the right parietal cortex in people with dyscalculia relative to controls. Functional MRI showed that accurate number semantic judgements were maintained by parietal and inferior frontal activations that were common to adults with dyscalculia and controls, with higher activation for participants with dyscalculia than controls in the right superior frontal cortex and the left inferior frontal sulcus. Enhanced activation in these frontal areas was driven by people with dyscalculia who made faster rather than slower numerical decisions; however, activation could not be accounted for by response times per se, because it was greater for fast relative to slow dyscalculics but not greater for fast controls relative to slow dyscalculics. In conclusion, our results reveal two frontal brain regions that support efficient number processing in dyscalculia.

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Dyscalculics (DD) show congenital number impairment due to parietal abnormalities.

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However DD often show residual number skills which have not been studied before.

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We studied the brain networks supporting residual skills and individual differences

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DD: reduced parietal grey-matter, accurate but slower than controls in number tasks

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Faster DD responses over-activated two frontal areas