Interaction of hand use and spatial selective attention in children

A meta-analysis of the line bisection task in children

Meta-analyses have shown subtle, group-level asymmetries of spatial attention in adults favouring the left hemispace (pseudoneglect). However, no meta-analysis has synthesized data on children. We performed a random-effects meta-analysis of spatial biases in children aged ≤16 years. Databases (PsycINFO, Web of Science & Scopus) and pre-print servers (bioRxiv, medRxiv & PsyArXiv) were searched for studies involving typically developing children with a mean age of ≤16, who were tested using line bisection. Thirty-three datasets, from 31 studies, involving 2101 children, were included. No bias was identified overall, but there was a small leftward bias in a subgroup where all children were aged ≤16. Moderator analysis found symmetrical neglect, with right-handed actions resulting in right-biased bisections, and left-handed actions in left-biased bisections. Bisections were more leftward in studies with a higher percentage of boys relative to girls. Mean age, hand preference, and control group status did not moderate biases, and there was no difference between children aged ≤7 and ≥7 years, although the number of studies in each moderator analysis was small. There was no evidence of small study bias. We conclude that pseudoneglect may be present in children but is dependent on individual characteristics (sex) and/or task demands (hand used).Registration: Open Science Framework (https://osf.io/n68fz/).

Revisiting the attentional bias in the split brain

Previous research has revealed a strong right bias in allocation of attention in split brain subjects, suggesting that a pathological attention bias occurs not only after unilateral (usually right-hemispheric) damage but also after functional disconnection of intact right-hemispheric areas involved in allocation of attention from those in the left hemisphere. Here, we investigated the laterality bias in spatial attention, as measured with the greyscales task, in two split-brain subjects (D.D.C. and D.D.V.) who had undergone complete callosotomy. The greyscales task requires participants to judge the darker (or brighter) of two left-right mirror-reversed luminance gradients under conditions of free viewing, and offers an efficient means of quantifying pathological attentional biases in patients with unilateral lesions. As predicted, the results of the two split-brain subjects revealed a pathological rightward bias in allocation of attention, suggesting strong dependence on a single hemisphere (the left) in spatial attention, which is opposite to what one expects from people with intact commissures, and is remarkable in that it occurs in free viewing. In that sense both split-brain patients are behaving as though the brain is indeed split, especially in D.D.C. who had undergone partial resection of the anterior commissure in addition to complete callosotomy, whereas the anterior commissure is still intact in D.D.V. The findings support the view that the commissural pathways play a significant role in integration of attentional processes across cerebral hemispheres.

Development of spatial biases in school-aged children

In the adult brain, biases in the allocation of spatial attention can be measured using a line bisection task and are directly relatable to neural attention signals in the fronto-parietal attention network. Behavioral studies on the development of spatial biases have yielded a host of inconsistent results, likely due to variance in sample size, definition of experimental groups, and motor confounds introduced by using a paper-and-pencil version of a line bisection task. Here, we used a perceptual, computerized version of this task and examined the development of spatial biases in 459 children from grades 1-8 and 61 college freshmen. We found that children in early elementary grades exerted a significant leftward bias that gradually diminished with advancing grade level. We further show that among children in early elementary school grades, the degree of leftward spatial bias predicted better performance on a rapid automatized naming test, a predictor of reading ability. Significant leftward biases in early elementary school grades may be due to reading experience, thereby reflecting an interaction of the attention network with the evolving reading network.

Examining handedness and sex-related effects on line-bisection in childhood

Eighty-eight Bulgarian children (range 5 – 7 years old), 40 left handers (18 boys) and 48 right handers (26 boys), completed line-bisection test one time with each hand. In accordance with previous studies the results show that the majority of children demonstrated deviation to the left of the true center with the left hand and to the right with the right hand, suggesting symmetrical neglect. Sex, handedness and their interaction had no main effect on mean percentage deviation scores at the group level, but only sex had a significant impact on the frequency of symmetrical neglect (p < .05), with higher one in girls than in boys.

Development of Visuospatial Attention in Typically Developing Children

The aim of the present study is to investigate the development of visuospatial attention in typically developing children and to propose reference values for children for the following six visuospatial attention tests: star cancellation, Ogden figure, reading test, line bisection, proprioceptive pointing and visuo-proprioceptive pointing. Data of 159 children attending primary or secondary school in the Fédération Wallonie Bruxelles (Belgium) were analyzed. Results showed that the children's performance on star cancellation, Ogden figure and reading test improved until the age of 13 years, whereas their performance on proprioceptive pointing, visuo-proprioceptive pointing and line bisection was stable with increasing age. These results suggest that the execution of different types of visuospatial attention tasks are not following the same developmental trajectories. This dissociation is strengthened by the lack of correlation observed between tests assessing egocentric and allocentric visuospatial attention, except for the star cancellation test (egocentric) and the Ogden figure copy (ego- and allocentric). Reference values are proposed that may be useful to examine children with clinical disorders of visuospatial attention.

Hand preference, performance abilities, and hand selection in children

It is widely know that the pattern of human handedness is such that approximately 90% of the population is right handed with the remainder being left handed, at least in the adult population. What is less well understood is how handedness develops and at what age adult-like handedness patterns emerge. Quantified in terms of both preference and performance, a plethora of different behavioral assessments are currently in use with both children and adults. Handedness questionnaires are commonly used; however, these possess inherent limitations, considering their subjective nature. Hand performance measures have also been implemented; however, such tasks appear to measure different components of handedness. In addition to these traditional measures, handedness has been successfully assessed through observation of hand selection in reaching, which has proven to be a unique and effective manner in understanding the development of handedness in children. Research over the past several decades has demonstrated that young children display weak, inconsistent hand preference tendencies and are slower with both hands. Performance differences between the hands are larger for young children, and consistency improves with age. However, there remains some controversy surrounding the age at which hand preference and hand performance abilities can be considered fully developed. The following paper will provide a review of the literature pertaining to hand preference, performance abilities and hand selection in children in an attempt to ascertain the age at which adult-like patterns of hand preference and performance emerge.

Change of reference frame for tactile localization during child development

Temporal order judgements (TOJ) for two tactile stimuli, one presented to the left and one to the right hand, are less precise when the hands are crossed over the midline than when the hands are uncrossed. This 'crossed hand' effect has been considered as evidence for a remapping of tactile input into an external reference frame. Since late, but not early, blind individuals show such remapping, it has been hypothesized that the use of an external reference frame develops during childhood. Five- to 10-year-old children were therefore tested with the tactile TOJ task, both with uncrossed and crossed hands. Overall performance in the TOJ task improved with age. While children older than 5 1/2 years displayed a crossed hand effect, younger children did not. Therefore the use of an external reference frame for tactile, and possibly multisensory, localization seems to be acquired at age 5.

Spatial attentional bias as a marker of genetic risk, symptom severity, and stimulant response in ADHD

Attention-deficit hyperactivity disorder (ADHD) is a heritable childhood onset disorder that is marked by variability at multiple levels including clinical presentation, cognitive profile, and response to stimulant medications. It has been suggested that this variability may reflect etiological differences, particularly, at the level of underlying genetics. This study examined whether an attentional phenotype-spatial attentional bias could serve as a marker of symptom severity, genetic risk, and stimulant response in ADHD. A total of 96 children and adolescents with ADHD were assessed on the Landmark Task, which is a sensitive measure of spatial attentional bias. All children were genotyped for polymorphisms (3' untranslated (UTR) and intron 8 variable number of tandem repeats (VNTRs)) of the dopamine transporter gene (DAT1). Spatial attentional bias correlated with ADHD symptom levels and varied according to DAT1 genotype. Children who were homozygous for the 10-repeat allele of the DAT1 3'-UTR VNTR displayed a rightward attentional bias and had higher symptom levels compared to those with the low-risk genotype. A total of 26 of these children who were medication naive performed the Landmark Task at baseline and then again after 6 weeks of stimulant medication. Left-sided inattention (rightward bias) at baseline was associated with an enhanced response to stimulants at 6 weeks. Moreover, changes in spatial bias with stimulant medications, varied as a function of DAT1 genotype. This study suggests an attentional phenotype that relates to symptom severity and genetic risk for ADHD, and may have utility in predicting stimulant response in ADHD.

Differences in paper-and-pencil versus computerized line bisection according to ADHD subtype and hand-use

Two versions of the line bisection task, paper-and-pencil and computerized, were administered to non-medicated children (5-12 years) with and without Attention-Deficit/Hyperactivity Disorder (ADHD). Fifteen children were classified with ADHD-Inattentive type (ADHD-I), 15 were classified with ADHD-Combined or Hyperactive-Impulsive type (ADHD-C), and 15 children served as controls. During the paper-and-pencil task, and irrespective of hand-use, participants with ADHD-C bisected lines with a right bias, whereas participants with ADHD-I showed a leftwards bias. Interestingly, during the computerized version, an opposite pattern of hemineglect was observed with a leftwards bias for participants with ADHD-C and a rightwards bias for participants with ADHD-I. These findings suggest that different task demands are associated with the paper-and-pencil and computerized tasks. The findings also suggest that the two subtypes differ according to their cognitive profile, and possibly differ as to their underlying neural impairment.

Developmental changes in visual line bisection in women throughout adulthood

It has been suggested that some hemispheric asymmetries change in a systematic way from young adulthood to older age. However, little is known whether these changes are due to differential aging of a single hemisphere or based on age-related alterations of interhemispheric interactions. A sample of 281 right-handed neurologically healthy participants (151 women), ranging from age 20 to 79, was investigated with a line-bisection task. Previous studies indicate the midpoint estimation shows a consistent leftward bias from the veridical center, which is accentuated when the left hand is used to bisect lines. These findings support the view of a right hemispheric superiority in spatial attention. This study revealed this pattern to be stable in men throughout adulthood. However, women from 50 to 69 years of age showed a reduced leftward bias and a reduced hand effect compared to men and younger women. The results suggest that developmental changes in hemispheric asymmetry of spatial attention are more pronounced in women and support the view that neuromorphological changes during adulthood differ between sexes.

The Effect of Body and Environment-Centred Coordinates on Free-Viewing Perceptual Asymmetries for Vertical and Horizontal Stimuli

Leftward and upward perceptual biases are commonly reported for horizontal and vertical stimuli, respectively. It is unclear, however, whether these biases are based upon body or environment-centred coordinates. Two experiments examined the contribution of these coordinate systems to free-viewing vertical and horizontal perceptual biases. In Experiment 1, normal participants (n = 35) made forced-choice luminance judgments on two mirror-reversed luminance gradients (the 'greyscales' task) presented in vertical and horizontal orientations. Body and environment-based coordinates were dissociated by tilting participants' heads to the left or right. A leftward and upward bias, which was observed in the horizontal and vertical conditions (respectively) when the head was upright, was extinguished when the head was tilted. Results indicated a dual reliance on body and environmental coordinates with some suggestion that the upward bias was more dependent on environmental coordinates. In Experiment 2 the same stimuli were presented as participants (n = 24) adopted an upright or supine pose. Once again, leftward and upward biases were observed in the upright condition. The leftward bias persisted in the supine condition whereas the upward bias was eliminated. Results demonstrate that the leftward bias is based predominantly on body coordinates whereas the upward bias is reliant on environmental/gravitational coordinates. The possibility that the neural basis for the biases lies in the inter-modal centres of the intraparietal region of the right hemisphere is discussed.

Examining the relationship between rightward visuo-spatial bias and poor attention within the normal child population using a brief screening task

BACKGROUND

Some previous studies have linked Attention Deficit Hyperactivity Disorder (ADHD) with a bias in spatial awareness away from the left. As genetic research suggests that ADHD may be better viewed as an extreme on a continuum rather than a distinct entity, here we examined this issue in boys from the normal population.

METHOD

From an initial sample of 1811, two groups of boys characterised by very high (n = 58) or very low (n = 68) levels of ADHD-type behaviours were formed. The groups completed the spatially sensitive Line Bisection test and more general measures of (non-spatial) attention and intellectual function.

RESULTS

Boys whose bisections were consistent with relative inattention to the left indeed had higher ratings of ADHD-type behaviours and performed significantly more poorly on tests of sustained attention and executive function than boys whose bisections were in the normal range. In contrast, boys who showed extreme bisections in the opposite direction were not unusual either in ratings or test performance.

CONCLUSIONS

The results support an association between poor attention and a relative rightward bias in visual awareness that may stem from right hemisphere inefficiency.

Asymmetric deterioration of spatial awareness with diminishing levels of alertness in normal children and children with ADHD

BACKGROUND

There is growing literature suggesting that some children diagnosed with attention deficit hyperactivity disorder (ADHD) can show a significant bias in attention away from left space. Here we examine mechanisms that may underpin these effects in both clinical and non-clinical child populations. Unilateral spatial inattention (unilateral neglect) is a commonly reported consequence of stroke in adults. Although for most patients the problem is relatively transient, persistent forms of neglect are almost exclusively associated with right hemisphere lesions. It has been suggested that this chronicity may result from co-existing disruption to right hemisphere dominant systems that mediate alertness. Here we present two studies examining the relationship between sustained attention and left spatial awareness in childhood.

METHOD

In the first, normal children without the ADHD diagnosis were administered a non-spatial test of sustained attention/alertness. Children who performed poorly at this task, relative to their more attentive peers, showed a modest but reliable delay in awareness of left-sided visual information. Furthermore, attention towards the left declined for both groups as a function of time-on-task, suggesting a significant within-subject modulatory effect of alertness on spatial awareness. The second study examines this relationship in children referred to clinical services for attention problems. Irrespective of their final diagnosis, children were divided into two groups according to their performance in sustained attention/alertness tasks.

RESULTS

The results suggest that, regardless of the children's clinical diagnosis, diminished sustained attention/alertness levels formed the strongest predictor of relatively delayed awareness of information presented within left visual space. Two children within this group exhibited signs of hitherto undetected spatial neglect as severe as that observed in some brain-injured adults.

CONCLUSIONS

Clinical and theoretical implications are discussed.

Hemispheric asymmetry in spatial attention across the menstrual cycle

Functional cerebral asymmetries (FCAs) are known to fluctuate across the menstrual cycle. The mechanisms of these sex hormonal modulations are poorly understood. It has been suggested that gonadal steroid hormones might suppress or specifically activate one hemisphere. However, recent studies suggest that high levels of gonadal steroid hormones reduce FCAs by its modulating effects on cortico-cortical transmission. To investigate the activating effects of gonadal steroid hormones on the interhemispheric interaction, a visual line-bisection task was administered to normally cycling women during menses and the midluteal cycle phase as well as to similar-aged healthy men. The results replicate previous findings of a sex difference in line-bisection as a function of hand-use and show that the hand-use effect fluctuates across the menstrual cycle. High levels of estradiol during the midluteal phase were related to a decrease of the hand-use effect. It is concluded that cycle-related fluctuations in levels of gonadal steroid hormones affect hemispheric asymmetry of spatial attention, presumably by interhemispheric spreading of neuronal activation.

Rightward shift in spatial awareness with declining alertness

Although transient neglect of contralesional space occurs following damage to either hemisphere, persistent forms are overwhelmingly associated with right hemisphere lesions. This has led to the suggestion that impairments in other right hemisphere systems--in particular those that mediate alertness--may undermine recovery. Reductions in neglect severity with stimulation, exacerbation with sedatives and the poor performance of chronic neglect patients on sustained attention tasks are consistent with this view. However, the question of whether changes in alertness exert a specific influence over spatial attention--or simply improve performance across many domains--is difficult to address using only patient studies. Here, we examine this question with individuals from the healthy adult population. On certain spatial tasks, adults show a modest but reliable leftward attentional bias. On the basis of the neglect studies, we hypothesised that this bias would diminish--or even reverse--as alertness levels declined. In the first study, participants were asked to judge the relative lengths of the left and right sections of a line when sleep deprived and when well rested. A significant rightward shift in attention was associated with sleep deprivation. A rightward shift was also observed over the course of the session. The second study replicated this time-on-task effect. The results suggest that a diminution in alertness may be sufficient to induce a rightward shift in visual attention in the healthy brain. Implications for the persistence of neglect in patients, for spatial biases in children and for normal free viewing asymmetries are discussed.

A theory of marks and mind: the effect of notational systems on hominid brain evolution and child development with an emphasis on exchanges between mothers and children

A model of human language requires a theory of meaningful marks. Humans are the only species who use marks to think. A theory of marks identifies children's scribbles as significant behavior, while hypothesizing the importance of rotational systems to hominid brain evolution. By recognizing the importance of children's scribbles and drawings in developmental terms as well as in evolutionary terms, a marks-based rather than a predominantly speech-based theory of the human brain, language, and consciousness emerges. Combined research in anthropology, primatology, art history, neurology, child development (including research with deaf and blind children), gender studies and literacy suggests the importance of notational systems to human language, revealing the importance of mother/child interactions around marks and sounds to the development of an expressive, communicative, symbolic human brain. An understanding of human language is enriched by identifying marks carved on bone 1.9 million years ago as observational lunar calendar-keeping, pushing proto-literacy back dramatically. Neurologically, children recapitulate the meaningful marks of early hominins when they scribble and draw, reminding us that literacy belongs to humankind's earliest history. Even more than speech, such meaningful marks played - and continue to play - decisive roles in human brain evolution. The hominid brain required a model for integrative, transformative neural transfer. The research strongly suggests that humankind's multiple literacies (art, literature, scientific writing, mathematics and music) depended upon dyadic exchanges between hominid mothers and children, and that this exchange and sharing of visuo-spatial information drove the elaboration of human speech in terms of syntax, grammar and vocabulary. The human brain was spatial before it was linguistic. The child scribbles and draws before it speaks or writes. Children babble and scribble within the first two years of life. Hands and mouths are proximal on the sensory-motor cortex. Gestures accompany speech. Illiterate brains mis-pronounce nonsense sounds. Literate brains do not. Written language (work of the hands) enhances spoken language (work of the mouth). Until brain scans map the neurological links between human gesture, speech and marks in the context of mother/caregiver/child interactions, and research with literate and illiterate brains document even more precisely the long-term differences between these brains, the evolutionary pressure of marks on especially flexible maternal and infant brain tissue that occurred 1.9 million years, radically changing primate brain capabilities, requires an integrated theory of marks and mind.

Age and responding-hand related changes in performance of neurologically normal subjects on the line-bisection and chimeric-faces tasks

This study investigated age and responding-hand (left, right, and bimanual) related changes in visuospatial attention. Two tasks were completed by 107 neurologically normal right-handed subjects ranging in age from 5 to 70 years and distributed across four age groups. Task-specific differences between groups were apparent. In the line-bisection task, the younger and older groups displayed symmetrical neglect while the young and middle groups displayed pseudoneglect. In the chimeric-faces task the leftward bias was less pronounced in the older group and more susceptible to responding-hand effects in the middle and older groups. Whilst results, especially those of the bimanual method, provided strong support for an activation model, they imposed an age limitation on its appropriateness as an explanation for performance on the chimeric-faces task. Results are discussed as reflecting changes in the corpus callosum and right hemisphere.

Line Bisection in the Split Brain

The authors examined line bisection in 4 patients with resection of the corpus callosum and in 22 control participants. The control participants showed a leftward bias, especially with the left hand, implying right-hemispheric dominance in spatial attention. Two patients with anterior callosotomy showed similar biases, suggesting that the anterior callosum plays only a small role. A patient with complete callosotomy showed a strong right bias, regardless of hand use. A patient with posterior callosotomy showed the opposite pattern: a strong left bias, regardless of hand use. These data suggest that the posterior corpus callosum normally plays a role in line bisection and that the resection of the posterior corpus callosum produces consistent bias. The direction of the bias depends on which hemisphere assumes control.