On the automaticity/cerebellar deficit hypothesis of dyslexia: balancing and continuous rapid naming in dyslexic and ADHD children

Adenosinergic system and nucleoside transporters in attention deficit hyperactivity disorder: Current findings

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high heterogeneity that can affect individuals of any age. It is characterized by three main symptoms: inattention, hyperactivity, and impulsivity. These neurobehavioral alterations and neurochemical and pharmacological findings are mainly attributed to unbalanced catecholaminergic signaling, especially involving dopaminergic pathways within prefrontal and striatal areas. Dopamine receptors and transporters are not solely implicated in this imbalance, as evidence indicates that the dopaminergic signaling is modulated by adenosine activity. To this extent, alterations in adenosinergic signaling are probably involved in ADHD. Here, we review the current knowledge about adenosine's role in the modulation of chemical, behavioral and cognitive parameters of ADHD, especially regarding dopaminergic signaling. Current literature usually links adenosine receptors signaling to the dopaminergic imbalance found in ADHD, but there is evidence that equilibrative nucleoside transporters (ENTs) could also be implicated as players in dopaminergic signaling alterations seen in ADHD, since their involvement in other neurobehavioral impairments.

What Factors Contribute to Reading in ADHD: Examining Reading-Related Skills in Children With ADHD Only/Comorbid Developmental Dyslexia

BACKGROUND

ADHD and developmental dyslexia (DD) frequently co-occur. However, it is unclear why some children with ADHD acquire DD while others do not.

METHODS

A total of 830 children (including typically developing controls, ADHD only, DD only, and ADHD + DD groups) of two ages (younger: first-third grade; older: fourth-sixth grade) were assessed on measures of reading ability and reading-related skills.

RESULTS

The clinical groups had different degrees of impairment in each reading-related skill. Regression results found that the four groups had different skills in predicting reading ability in younger and older grades. Especially, rapid automatized naming (RAN) was the only predictor of reading ability in children with ADHD only.

CONCLUSIONS

The study highlights that RAN plays an important role in the reading development of children with ADHD only, reflecting the possible protective role of RAN in reading development.

Multiple Case Studies in German Children with Dyslexia: Characterization of Phonological, Auditory, Visual, and Cerebellar Processing on the Group and Individual Levels

BACKGROUND

The underlying mechanisms of dyslexia are still debated. The question remains as to whether there is evidence of a predominant type of deficit or whether it is a multideficit disorder with individual profiles. The assumptions of which mechanism causes the disorder influences the selection of the training approach.

METHODS

A sample of German neurotypical reading children (NT) and children with dyslexia (DYSL) was investigated with a comprehensive behavioral test battery assessing phonological, auditory, visual, and cerebellar performance, thus addressing performance described in three major theories in dyslexia.

RESULTS

In the present sample using the test battery of the present study, DYSL had the strongest impairment in phonological and auditory processing, accompanied by individual processing deficits in cerebellar performance, but only a few in the investigated visual domains. Phonological awareness and auditory performance were the only significant predictors for reading ability.

CONCLUSION

These findings point out that those reading difficulties were associated with phonological as well as auditory processing deficits in the present sample. Future research should investigate individual deficit profiles longitudinally, with studies starting before literacy acquisition at as many processing domains as possible. These individual deficit profiles should then be used to select appropriate interventions to promote reading and spelling.

The cognitive basis of dyslexia in school-aged children: A multiple case study in a transparent orthography

This study focuses on the role of numerous cognitive skills such as phonological awareness (PA), rapid automatized naming (RAN), visual and selective attention, auditory skills, and implicit learning in developmental dyslexia. We examined the (co)existence of cognitive deficits in dyslexia and assessed cognitive skills’ predictive value for reading. First, we compared school‐aged children with severe reading impairment (n = 51) to typical readers (n = 71) to explore the individual patterns of deficits in dyslexia. Children with dyslexia, as a group, presented low PA and RAN scores, as well as limited implicit learning skills. However, we found no differences in the other domains. We found a phonological deficit in 51% and a RAN deficit in 26% of children with dyslexia. These deficits coexisted in 14% of the children. Deficits in other cognitive domains were uncommon and most often coexisted with phonological or RAN deficits. Despite having a severe reading impairment, 26% of children with dyslexia did not present any of the tested deficits. Second, in a group of children presenting a wide range of reading abilities (N = 211), we analysed the relationship between cognitive skills and reading level. PA and RAN were independently related to reading abilities. Other skills did not explain any additional variance. The impact of PA and RAN on reading skills differed. While RAN was a consistent predictor of reading, PA predicted reading abilities particularly well in average and good readers with a smaller impact in poorer readers.

The Neurological Basis of Developmental Dyslexia and Related Disorders: A Reappraisal of the Temporal Hypothesis, Twenty Years on

In a now-classic article published a couple of decades ago (Brain, 2000; 123: 2373-2399), I proposed an "extended temporal processing deficit hypothesis of dyslexia", suggesting that a deficit in temporal processing could explain not only language-related peculiarities usually noticed in dyslexic children, but also a wider range of symptoms related to impaired processing of time in general. In the present review paper, I will revisit this "historical" hypothesis both in the light of a new clinical perspective, including the central yet poorly explained notion of comorbidity, and also taking a new look at the most recent experimental work, mainly focusing on brain imaging data. First, consistent with daily clinical practice, I propose to distinguish three groups of children who fail to learn to read, of fairly equal occurrence, who share the same initial presentation (difficulty in mastering the rules of grapheme-phoneme correspondence) but with differing associated signs and/or comorbid conditions (language disorders in the first group, attentional deficits in the second one, and motor coordination problems in the last one), thus suggesting, at least in part, potentially different triggering mechanisms. It is then suggested, in the light of brain imaging information available to date, that the three main clinical presentations/associations of cognitive impairments that compromise reading skills acquisition correspond to three distinct patterns of miswiring or "disconnectivity" in specific brain networks which have in common their involvement in the process of learning and their heavy reliance on temporal features of information processing. With reference to the classic temporal processing deficit of dyslexia and to recent evidence of an inability of the dyslexic brain to achieve adequate coupling of oscillatory brain activity to the temporal features of external events, a general model is proposed according to which a common mechanism of temporal uncoupling between various disconnected-and/or mis-wired-processors may account for distinct forms of specific learning disorders, with reading impairment being a more or less constant feature. Finally, the potential therapeutic implications of such a view are considered, with special emphasis on methods seeking to enhance cross-modal connectivity between separate brain systems, including those using rhythmic and musical training in dyslexic patients.

Animal models of attention-deficit hyperactivity disorder (ADHD)

Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous neuropsychiatric disorder characterized by three primary symptoms hyperactivity, attention deficit, and impulsiveness, observed in both children and adults. In childhood, this disorder is more common in boys than in girls, and at least 75% will continue to suffer from the disorder until adulthood. Individuals with ADHD generally have poor academic, occupational, and social functioning resulting from developmentally inappropriate levels of hyperactivity and impulsivity, as well as impaired ability to maintain attention on motivationally relevant tasks. Very few drugs available in clinical practice altogether abolish the symptoms of ADHD, therefore, to find new drugs and target it is essential to understand the neuropathological, neurochemical, and genetic alterations that lead to the progression of ADHD. With this contrast, an animal study is the best approach because animal models provide relatively fast invasive manipulation, rigorous hypothesis testing, as well as it provides a better angle to understand the pathological mechanisms involved in disease progression. Moreover, animal models, especially for ADHD, serve with good predictive validity would allow the assessment and development of new therapeutic interventions, with this aim, the present review collect the various animal models on a single platform so that the research can select an appropriate model to pursue his study.

Intrinsic Cerebro-Cerebellar Functional Connectivity Reveals the Function of Cerebellum VI in Reading-Related Skills

The engagement of the cerebellum VI in reading was reported in both typically developing and dyslexic readers. However, it is still not clear how the cerebellum VI contributes to reading. Here we have examined the correlation of intrinsic cerebro-cerebellar functional connectivity with two critical reading-related skills—phonological awareness (PA) and rapid automatized naming (RAN)—with fMRI technology. Specifically, we tested the hypothesis that the cerebellum may contribute to reading either by phonological skills or by automatizing skills. We chose the left and right cerebellum VI as ROIs, and we calculated the intrinsic cerebro-cerebellar functional connectivity during a resting state. We further explored whether and how cerebro-cerebellar resting state functional connectivity (RSFC) is associated with individuals’ reading-related skills including PA and RAN. The results showed that the functional connectivity between the left supramarginal gyrus and bilateral cerebellum VI was related to RAN, and the connectivity between the left insula and right cerebellum VI was related to PA. However, the effect of PA did not survive after the RAN was regressed out. Control analyses further confirmed that it was the intrinsic cerebro-cerebellar functional connectivity rather than the local cerebellar functionality that associated with phonological awareness ability and rapid automatized naming ability. For the first time, the relationship between cerebro-cerebellar resting state functional connectivity and specific reading-related skills has been explored, and this has deepened our understanding of the way the cerebellum VI is involved in reading.

Balance Training as an Adjunct to Methylphenidate: A Randomized Controlled Pilot Study of Behavioral Improvement Among Children With ADHD in China

Objective: This study aimed to compare the therapeutic effects of two different approaches to attention deficit hyperactivity disorder (ADHD): (1) methylphenidate (MPH) treatment combined with balance training, and (2) MPH monotherapy. Methods: The study was based on a randomized, single-blind trial involving 27 ADHD patients. An experimental group received the treatment combining MPH and balance training, while a control group were administered just MPH. After 40 sessions of training at the 6-month mark, patients' improvement as observed in their core symptoms and behavioral problems were compared between the experimental and control group. Results: A total of 27 patients underwent randomization, with 13 assigned to the experimental group and 14 to the control group. After the 6-month trial, the experimental group outperformed the control group in terms of teachers' scores for inattention on the ADHD-RS-IV (19.38 ± 2.96 vs. 23.21 ± 3.91, t = -2.854, P = 0.009). The experimental group also showed greater improvement on the items involving behavior (3.14 ± 1.46 vs. 5.24 ± 1.04, t = 1.463, P = 0.026) and hyperactivity (1.92 ± 1.19 vs. 3.86 ± 2.32, t = -2.697, P = 0.012). Conclusion: In children with ADHD, the experimental group displayed a significant improvement in the symptoms and behavior associated with inattention than did the group whose treatment consisted of only MPH.

Mapping the neuroanatomic substrates of cognition in familial attention deficit hyperactivity disorder

BACKGROUND

While the neuroanatomic substrates of symptoms of attention deficit hyperactivity disorder (ADHD) have been investigated, less is known about the neuroanatomic correlates of cognitive abilities pertinent to the disorder, particularly in adults. Here we define the neuroanatomic correlates of key cognitive abilities and determine if there are associations with histories of psychostimulant medication.

METHODS

We acquired neuroanatomic magnetic resonance imaging data from 264 members of 60 families (mean age 29.5; s.d. 18.4, 116 with ADHD). Using linear mixed model regression, we tested for associations between cognitive abilities (working memory, information processing, intelligence, and attention), symptoms and both cortical and subcortical volumes.

RESULTS

Symptom severity was associated with spatial working memory (t = -3.77, p = 0.0002), processing speed (t = -2.95, p = 0.004) and a measure of impulsive responding (t = 2.19, p = 0.03); these associations did not vary with age (all p > 0.1). Neuroanatomic associations of cognition varied by task but centered on prefrontal, lateral parietal and temporal cortical regions, the thalamus and putamen. The neuroanatomic correlates of ADHD symptoms overlapped significantly with those of working memory (Dice's overlap coefficient: spatial, p = 0.003; verbal, p = 0.001) and information processing (p = 0.02). Psychostimulant medication history was associated with neither cognitive skills nor with a brain-cognition relationships.

CONCLUSIONS

Diagnostic differences in the cognitive profile of ADHD does not vary significantly with age; nor were cognitive differences associated with psychostimulant medication history. The neuroanatomic substrates of working memory and information overlapped with those for symptoms within these extended families, consistent with a pathophysiological role for these cognitive skills in familial ADHD.

Identifying dyslexia risk for sport-related concussion management: Sensitivity and specificity of self-report and rapid naming

BACKGROUND

Dyslexia is the most common type of learning disability and studies have shown that student-athletes with learning disabilities sustain more concussions than their non-affected peers. However, current methods of dyslexia identification in college students are potentially invalid because they rely on students to self-report formal dyslexia diagnoses.

METHODS

To test the accuracy of self-report against two alternative methods of dyslexia screening, 94 college students completed three dyslexia symptom inventories, two rapid naming (RAN) tasks, and a standard word reading measure.

RESULTS

Reliability was acceptable for screening purposes on the inventories (α =.70, -.72), and excellent for RAN (α = .91, -.94). Specificity was acceptable (82.5%), but sensitivity was low (14.3%) when students self-reported suspected diagnoses of reading impairment. Sensitivity and specificity were higher for the digit RAN task (71 and 98%, respectively) compared to the letter RAN task (57 and 90%). Sensitivity (92.7%) and specificity (92.5%) were optimal when a cut-score of ≥27 seconds was used. A binary logistic regression showed digit RAN alone significantly predicted whether students were classified as typical or inefficient readers, p< .001, whereas the most reliable dyslexia inventory alone did not, p=.284. Including inventories along with RAN provided no additional predictive value.

CONCLUSION

Self-report inventories missed many cases of inefficient word reading. The digit RAN task classified 93.6% of the cases correctly compared to 72.3% for self-report inventory. Thus, we recommend that neuropsychologists working with college concussion management programs add to their baseline screening protocols the digit RAN task, which can be completed in less than one minute.

Cognitive predictors of sequential motor impairments in children with dyslexia and/or attention deficit/hyperactivity disorder

This study examined cognitive predictors of sequential motor skills in 215 children with dyslexia and/or attention deficit/hyperactivity disorder (ADHD). Visual working memory and math fluency abilities contributed significantly to performance of sequential motor abilities in children with dyslexia (N = 67), ADHD (N = 66) and those with a comorbid diagnosis (N = 82), generally without differentiation between groups. In addition, primary diagnostic features of each disorder, such as reading and inattention, did not contribute to the variance in motor skill performance of these children. The results support a unifying framework of motor impairment in children with neurodevelopmental disorders such as dyslexia and ADHD.

Which neuropsychological functions predict various processing speed components in children with and without attention-deficit/hyperactivity disorder?

We identified statistical predictors of four processing speed (PS) components in a sample of 151 children with and without attention-deficit/hyperactivity disorder (ADHD). Performance on perceptual speed was predicted by visual attention/short-term memory, whereas incidental learning/psychomotor speed was predicted by verbal working memory. Rapid naming was predictive of each PS component assessed, and inhibition predicted all but one task, suggesting a shared need to identify/retrieve stimuli rapidly and inhibit incorrect responding across PS components. Hence, we found both shared and unique predictors of perceptual, cognitive, and output speed, suggesting more specific terminology should be used in future research on PS in ADHD.

Feedforward motor control in developmental dyslexia and developmental coordination disorder: Does comorbidity matter?

BACKGROUND AND AIM

Feedforward and online controls are two facets of predictive motor control from internal models, which is suspected to be impaired in learning disorders. We examined whether the feedforward component is affected in children (8-12 years) with developmental dyslexia (DD) and/or with developmental coordination disorder (DCD) compared to typically developing (TD) children.

METHODS

Children underwent a bimanual unloading paradigm during which a load supported to one arm, the postural arm, was either unexpectedly unloaded by a computer or voluntary unloaded by the subject with the other arm.

RESULTS

All children showed a better stabilization (lower flexion) of the postural arm and an earlier inhibition of the arm flexors during voluntary unloading, indicating anticipation of unloading. Between-group comparisons of kinematics and electromyographic activity of the postural arm revealed that the difference during voluntary unloading was between DD-DCD children and the other groups, with the former showing a delayed inhibition of the flexor muscles.

CONCLUSION

Deficit of the feedforward component of motor control may particularly apply to comorbid subtypes, here the DD-DCD subtype. The development of a comprehensive framework for motor performance deficits in children with learning disorders will be achieved only by dissociating key components of motor prediction and focusing on subtypes and comorbidities.

Postural Control in Children with Dyslexia: Effects of Emotional Stimuli in a Dual-Task Environment

The aim of this study was to compare the visual exploration strategies used during a postural control task across participants with and without dyslexia. We simultaneously recorded eye movements and postural control while children were viewing different types of emotional faces. Twenty-two children with dyslexia and twenty-two aged-matched children without dyslexia participated in the study. We analysed the surface area, the length and the mean velocity of the centre of pressure for balance in parallel with visual saccadic latency, the number of saccades and the time spent in regions of interest. Our results showed that postural stability in children with dyslexia was weaker and the surface area of their centre of pressure increased significantly when they viewed an unpleasant face. Moreover, children with dyslexia had different strategies to those used by children without dyslexia during visual exploration, and in particular when they viewed unpleasant emotional faces. We suggest that lower performance in emotional face processing in children with dyslexia could be due to a difference in their visual strategies, linked to their identification of unpleasant emotional faces. Copyright © 2017 John Wiley & Sons, Ltd.

Gait in Children with Attention-Deficit Hyperactivity Disorder in a Dual-Task Paradigm

The aim was to examine gait in school-aged children with attention-deficit hyperactivity disorder (ADHD) and typically developing controls in a dual-task paradigm. Thirty children with ADHD (without or off medication) aged 7-13 years and 28 controls walked without an additional task (single-task walking) and while performing a concurrent cognitive or motor task (dual-task walking). Gait was assessed using GAITRite recordings of spatiotemporal and variability gait parameters. Compared to single-task walking, dual-tasking significantly altered walking performance of children with and without ADHD, whereby dual-task effects on gait were not different between the two groups. For both children with ADHD and controls the motor concurrent task had a stronger effect on gait than the cognitive concurrent task. Gait in children with and without ADHD is affected in a dual-task paradigm indicating that walking requires executive functions. Future investigations of children's dual-task walking should account for the type of concurrent tasks.

Dissociation between exact and approximate addition in developmental dyslexia

Previous research has suggested that number sense and language are involved in number representation and calculation, in which number sense supports approximate arithmetic, and language permits exact enumeration and calculation. Meanwhile, individuals with dyslexia have a core deficit in phonological processing. Based on these findings, we thus hypothesized that children with dyslexia may exhibit exact calculation impairment while doing mental arithmetic. The reaction time and accuracy while doing exact and approximate addition with symbolic Arabic digits and non-symbolic visual arrays of dots were compared between typically developing children and children with dyslexia. Reaction time analyses did not reveal any differences across two groups of children, the accuracies, interestingly, revealed a distinction of approximation and exact addition across two groups of children. Specifically, two groups of children had no differences in approximation. Children with dyslexia, however, had significantly lower accuracy in exact addition in both symbolic and non-symbolic tasks than that of typically developing children. Moreover, linguistic performances were selectively associated with exact calculation across individuals. These results suggested that children with dyslexia have a mental arithmetic deficit specifically in the realm of exact calculation, while their approximation ability is relatively intact.

Double-Deficit Hypothesis in a Clinical Sample: Extension Beyond Reading

This study explored the double-deficit hypothesis (DDH) in a transparent orthography (Finnish) and extended the view from reading disabilities to comorbidity of learning-related problems in math and attention. Children referred for evaluation of learning disabilities in second through sixth grade (N = 205) were divided into four groups based on rapid automatized naming (RAN) and phonological awareness (PA) according to the DDH: the double-deficit group, the naming speed deficit-only group, the phonological deficit-only group, and the no-deficit group. The results supported the DDH in that the prevalence and severity of reading disability were greatest in the double-deficit group. Despite the greater prevalence of reading disabilities in single-deficit groups compared to the no-deficit group, the means of reading measures in the single-deficit groups were similar to those of the no-deficit group. The PA single-deficit group was poorer in spelling than the no-deficit group and single-naming-deficit group. Deficits in RAN or PA were primarily linked to reading disabilities but not with math or attention problems. The results supported the DDH partially and indicate that deficits in RAN and PA are specific to reading disabilities.

How Is RAN Related to Reading Fluency? A Comprehensive Examination of the Prominent Theoretical Accounts

We examined the prominent theoretical explanations of the RAN-reading relationship in a relatively transparent language (Greek) in a sample of children (n = 286) followed from Grade 1 to Grade 2. Specifically, we tested the fit of eight different models, as defined by the type of reading performance predicted (oral vs. silent word reading fluency), the type of RAN tasks (non-alphanumeric vs. alphanumeric), and the RAN effects (direct vs. indirect). Working memory, attention, processing speed, and motor skills were used as "common cause" variables predicting both RAN and reading fluency and phonological awareness and orthographic processing were used as mediators of RAN's effects on reading fluency. The findings of both concurrent and longitudinal analyses indicated that RAN is a unique predictor of oral reading fluency, but not silent reading fluency. Using alphanumeric or non-alphanumeric RAN did not particularly affect the RAN-reading relationship. Both phonological awareness and orthographic processing partly mediated RAN's effects on reading fluency. Theoretical implications of these findings are discussed.

Rapid Naming in Brazilian Students with Dyslexia and Attention Deficit Hyperactivity Disorder

INTRODUCTION

The effective development of reading and writing skills requires the concerted action of several abilities, one of which is phonological processing. One of the main components of phonological processing is rapid automatized naming (RAN)-the ability to identify and recognize a given item by the activation and concomitant articulation of its name.

OBJECTIVE

To assess the RAN performance of schoolchildren with dyslexia and attention deficit hyperactivity disorder (ADHD) compared with their peers.

METHODS

In total, 70 schoolchildren aged between 8 and 11 years participated in the study. Of these, 16 children had a multiprofessional diagnosis of ADHD while 14 were diagnosed with dyslexia. Matched with these groups, 40 schoolchildren with no history of developmental impairments were also evaluated. The RAN test was administered to assess the length of time required to name a series of familiar visual stimuli. The statistical analysis was conducted using measures of descriptive statistics and the 2-sample t-test at the 5% significance level.

RESULTS

The performance of the group with dyslexia was inferior to that of the control group in all tasks and the ADHD group had inferior performance for color and letters-naming tasks. The schoolchildren with dyslexia and those with ADHD showed very similar response times. Age was an important variable to be analyzed separately. As they aged, children with typical language development had fast answers on colors and digits tasks while children with dyslexia or ADHD did not show improvement with age.

CONCLUSIONS

The schoolchildren with dyslexia took longer to complete all tasks and ADHD took longer to complete digits and objects tasks in comparison to their peers with typical development. This ability tended to improve with age, which was not the case, however, with schoolchildren who had ADHD or dyslexia.

Postural control is not systematically related to reading skills: implications for the assessment of balance as a risk factor for developmental dyslexia

Impaired postural control has been associated with poor reading skills, as well as with lower performance on measures of attention and motor control variables that frequently co-occur with reading difficulties. Measures of balance and motor control have been incorporated into several screening batteries for developmental dyslexia, but it is unclear whether the relationship between such skills and reading manifests as a behavioural continuum across the range of abilities or is restricted to groups of individuals with specific disorder phenotypes. Here were obtained measures of postural control alongside measures of reading, attention and general cognitive skills in a large sample of young adults (n = 100). Postural control was assessed using centre of pressure (CoP) measurements, obtained over 5 different task conditions. Our results indicate an absence of strong statistical relationships between balance measures with either reading, cognitive or attention measures across the sample as a whole.

Balance in children with attention deficit hyperactivity disorder-combined type

The balance ability in children with attention deficit hyperactivity disorder-combined type (ADHD-C) has not been fully examined, particularly dynamic sitting balance. Moreover, the findings of some published studies are contradictory. We examined the static and dynamic sitting balance ability in 20 children with ADHD-C (mean age: 9 years 3 months; 18 boys, 2 girls) and 20 age-, sex-, height-, weight-, and IQ-matched healthy and typically developing controls (mean age: 9 years 2 months; 18 boys, 2 girls). The balance subtests of the Movement Assessment Battery for Children (MABC) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were used to compare the two groups, and a mechanical horseback riding test was recorded using a motion-capture system. Compared with the controls, children with ADHD-C had less-consistent patterns of movement, more deviation of movement area, and less-effective balance strategies during mechanical horseback riding. In addition, their performance on the balance subtests of the MABC and BOTMP were not as well as those of the controls. Our findings suggest that balance ability skill levels in children with ADHD-C were generally not as high as those of the controls in various aspects, including static and dynamic balance.

The interface between spoken and written language: developmental disorders

We review current knowledge about reading development and the origins of difficulties in learning to read. We distinguish between the processes involved in learning to decode print, and the processes involved in reading for meaning (reading comprehension). At a cognitive level, difficulties in learning to read appear to be predominantly caused by deficits in underlying oral language skills. The development of decoding skills appears to depend critically upon phonological language skills, and variations in phoneme awareness, letter-sound knowledge and rapid automatized naming each appear to be causally related to problems in learning to read. Reading comprehension difficulties in contrast appear to be critically dependent on a range of oral language comprehension skills (including vocabulary knowledge and grammatical, morphological and pragmatic skills).

Fine motor deficits in reading disability and language impairment: same or different?

Several studies have found evidence of motor deficits in poor readers. There is no obvious reason for motor and literacy skills to go together, and it has been suggested that both deficits could be indicative of an underlying problem with cerebellar function and/or procedural learning. However, the picture is complicated by the fact that reading problems often co-occur with oral language impairments, which have also been linked with motor deficits. This raises the question of whether motor deficits characterise poor readers when language impairment has been accounted for - and vice versa. We considered these questions by assessing motor deficits associated with reading disability (RD) and language impairment (LI). A large community sample provided a subset of 9- to 10-year-olds, selected to oversample children with reading and/or language difficulties, to give 37 children with comorbid LI + RD, 67 children with RD only, 32 children with LI only, and 117 typically-developing (TD) children with neither type of difficulty. These children were given four motor tasks that taxed speed, sequence, and imitation abilities to differing extents. Different patterns of results were found for the four motor tasks. There was no effect of RD or LI on two speeded fingertip tapping tasks, one of which involved sequencing of movements. LI, but not RD, was associated with problems in imitating hand positions and slowed performance on a speeded peg-moving task that required a precision grip. Fine motor deficits in poor readers may be more a function of language impairment than literacy problems.

Cerebellar function in developmental dyslexia

Developmental dyslexia is a genetically based neurobiological syndrome, which is characterized by reading difficulty despite normal or high general intelligence. Even remediated dyslexic readers rarely achieve fast, fluent reading. Some dyslexics also have impairments in attention, short-term memory, sequencing (letters, word sounds, and motor acts), eye movements, poor balance, and general clumsiness. The presence of "cerebellar" motor and fluency symptoms led to the proposal that cerebellar dysfunction contributes to the etiology of dyslexia. Supporting this, functional imaging studies suggest that the cerebellum is part of the neural network supporting reading in typically developing readers, and reading difficulties have been reported in patients with cerebellar damage. Differences in both cerebellar asymmetry and gray matter volume are some of the most consistent structural brain findings in dyslexics compared with good readers. Furthermore, cerebellar functional activation patterns during reading and motor learning can differ in dyslexic readers. Behaviorally, some children and adults with dyslexia show poorer performance on cerebellar motor tasks, including eye movement control, postural stability, and implicit motor learning. However, many dyslexics do not have cerebellar signs, many cerebellar patients do not have reading problems, and differences in dyslexic brains are found throughout the whole reading network, and not isolated to the cerebellum. Therefore, impaired cerebellar function is probably not the primary cause of dyslexia, but rather a more fundamental neurodevelopmental abnormality leads to differences throughout the reading network.

Motor regulation problems and pain in adults diagnosed with ADHD

Background

Most children who are diagnosed with attention deficit-hyperactivity disorder (ADHD) have moderate-to-severe motor problems using the Motor Function Neurological Assessment battery (MFNU). The MFNU focuses on specific muscle adjustment problems associated with ADHD, especially motor inhibition problems and high muscle tone. Here we investigated whether adults with ADHD/hyperkinetic disorder (HKD) have similar motor problems. In our clinical experience, adults with ADHD often complain about back, shoulder, hip, and leg pain. We also investigate reported pain in adults with ADHD.

Methods

Twenty-five adult outpatients diagnosed with ADHD/HKD who were responders to methylphenidate (MPH) were compared to 23 non-ADHD controls on 16 MFNU subtests and using a ‘total score’ (‘TS’) parameter. The MFNU test leader was blinded to group identity. The two groups were also compared using the Pain Drawing and Numerical Pain Rating Scale.

Results

The adult ADHD group had significantly (p < .001) more motor problems (higher TS) than controls. On the muscle regulation subtests, 36–96% of the ADHD group showed ‘moderate’ to ‘severe’ problems compared to 13–52% of the control group, and 80% of the ADHD group reported widespread pain. Highly significant differences were found between the ADHD and control groups for the variables ‘pain level’ (p < .001) and ‘pain location’ (p < .001). Significant correlations were found between TS and ‘pain location’ and between TS and ‘pain level’.

Conclusions

These findings suggest that similar to children with ADHD, adults diagnosed with ADHD also have motor inhibition problems and heightened muscle tone. The presence of significantly higher pain levels and more widespread pain in the ADHD group compared to non-ADHD controls might indicate that pain is a long-term secondary effect of heightened muscle tone and restricted movement that can be demonstrated in children and adults by the MFNU battery.

Differences in learning volitional (manual) and non-volitional (posture) aspects of a complex motor skill in young adult dyslexic and skilled readers

The 'Cerebellar Deficit Theory' of developmental dyslexia proposes that a subtle developmental cerebellar dysfunction leads to deficits in attaining 'automatic' procedures and therefore manifests as subtle motor impairments (e.g., balance control, motor skill learning) in addition to the reading and phonological difficulties. A more recent version of the theory suggests a core deficit in motor skill acquisition. This study was undertaken to compare the time-course and the nature of practice-related changes in volitional (manual) and non-volitional (posture) motor performance in dyslexic and typical readers while learning a new movement sequence. Seventeen dyslexic and 26 skilled young adult readers underwent a three-session training program in which they practiced a novel sequence of manual movements while standing in a quiet stance position. Both groups exhibited robust and well-retained gains in speed, with no loss of accuracy, on the volitional, manual, aspects of the task, with a time-course characteristic of procedural learning. However, the dyslexic readers exhibited a pervasive slowness in the initiation of volitional performance. In addition, while typical readers showed clear and well-retained task-related adaptation of the balance and posture control system, the dyslexic readers had significantly larger sway and variance of sway throughout the three sessions and were less efficient in adapting the posture control system to support the acquisition of the novel movement sequence. These results support the notion of a non-language-related deficit in developmental dyslexia, one related to the recruitment of motor systems for effective task performance rather than to a general motor learning disability.

Comorbid externalising behaviour in AD/HD: evidence for a distinct pathological entity in adolescence

While the profiling of subtypes of Attention Deficit Hyperactivity Disorder (AD/HD) have been the subject of considerable scrutiny, both psychometrically and psychophysiologically, little attention has been paid to the effect of diagnoses comorbid with AD/HD on such profiles. This is despite the greater than 80% prevalence of comorbidity under the DSM-IV-TR diagnostic definitions. Here we investigate the event related potential (ERP) and psychometric profiles of Controls, AD/HD, and comorbid AD/HD (particularly AD/HD+ODD/CD) groups on six neurocognitive tasks thought to probe the constructs of selective and sustained attention, response inhibition and executive function. Data from 29 parameters extracted from a child group (age range 6 to 12; 52 Controls and 64 AD/HD) and from an adolescent group (age range 13 to 17; 79 Controls and 88 AD/HD) were reduced via a Principal Components Analysis, the 6 significant eigenvectors then used as determinants of cluster membership via a Two-Step Cluster Analysis. Two clusters were found in the analysis of the adolescent age group - a cluster dominated by Control and AD/HD participants without comorbidity, while the second cluster was dominated by AD/HD participants with externalising comorbidity (largely oppositional defiant/conduct disorder ODD/CD). A similar segregation within the child age group was not found. Further analysis of these objectively determined clusters in terms of their clinical diagnoses indicates a significant effect of ODD/CD comorbidity on a concurrent AD/HD diagnosis. We conclude that comorbid externalising behaviour in AD/HD constitutes a distinct pathological entity in adolescence.

Grey matter alterations co-localize with functional abnormalities in developmental dyslexia: an ALE meta-analysis

The neural correlates of developmental dyslexia have been investigated intensively over the last two decades and reliable evidence for a dysfunction of left-hemispheric reading systems in dyslexic readers has been found in functional neuroimaging studies. In addition, structural imaging studies using voxel-based morphometry (VBM) demonstrated grey matter reductions in dyslexics in several brain regions. To objectively assess the consistency of these findings, we performed activation likelihood estimation (ALE) meta-analysis on nine published VBM studies reporting 62 foci of grey matter reduction in dyslexic readers. We found six significant clusters of convergence in bilateral temporo-parietal and left occipito-temporal cortical regions and in the cerebellum bilaterally. To identify possible overlaps between structural and functional deviations in dyslexic readers, we conducted additional ALE meta-analyses of imaging studies reporting functional underactivations (125 foci from 24 studies) or overactivations (95 foci from 11 studies ) in dyslexics. Subsequent conjunction analyses revealed overlaps between the results of the VBM meta-analysis and the meta-analysis of functional underactivations in the fusiform and supramarginal gyri of the left hemisphere. An overlap between VBM results and the meta-analysis of functional overactivations was found in the left cerebellum. The results of our study provide evidence for consistent grey matter variations bilaterally in the dyslexic brain and substantial overlap of these structural variations with functional abnormalities in left hemispheric regions.

Annual research review: the nature and classification of reading disorders--a commentary on proposals for DSM-5

This article reviews our understanding of reading disorders in children and relates it to current proposals for their classification in DSM-5. There are two different, commonly occurring, forms of reading disorder in children which arise from different underlying language difficulties. Dyslexia (as defined in DSM-5), or decoding difficulty, refers to children who have difficulty in mastering the relationships between the spelling patterns of words and their pronunciations. These children typically read aloud inaccurately and slowly, and experience additional problems with spelling. Dyslexia appears to arise principally from a weakness in phonological (speech sound) skills, and there is good evidence that it can be ameliorated by systematic phonic teaching combined with phonological awareness training. The other major form of reading difficulty is reading comprehension impairment. These children read aloud accurately and fluently, but have difficulty understanding what they have read. Reading comprehension impairment appears to arise from weaknesses in a range of oral language skills including poor vocabulary knowledge, weak grammatical skills and difficulties in oral language comprehension. We suggest that the omission of reading comprehension impairment from DSM-5 is a serious one that should be remedied. Both dyslexia and reading comprehension impairment are dimensional in nature, and show strong continuities with other disorders of language. We argue that recognizing the continuities between reading and language disorders has important implications for assessment and treatment, and we note that the high rates of comorbidity between reading disorders and other seemingly disparate disorders (including ADHD and motor disorders) raises important challenges for understanding these disorders.

Is a cerebellar deficit the underlying cause of reading disabilities?

This study investigated whether children with dyslexia differed in their performance on reading, phonological, rapid naming, motor, and cerebellar-related tasks and automaticity measures compared to reading age (RA)-matched and chronological age (CA)-matched control groups. Participants were 51 children attending mainstream English elementary schools in Quebec. All participants completed measures of IQ, word and nonword reading fluency, elision, nonword decoding, rapid naming, bead threading, peg moving, toe tapping, postural stability, and muscle tone. Results from both group contrasts and analyses at the individual case level did not provide support for claims of motor-cerebellar involvement in either typical or atypical reading acquisition. Results were more consistent with a phonological core process account of both typical reading and reading difficulty. Phonological deficits for children with dyslexia compared to RA-matched controls were, however, only evident in group contrasts. Findings thus also have important implications for identifying at-risk readers among their same-aged peers.

RD, ADHD, and their comorbidity from a dual route perspective

In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.

Predictors of postural stability in children with ADHD

OBJECTIVE

As children with ADHD who have more inattention problems are more frequently with fine motor problems, it is not clear whether postural balance problems are associated with different subtypes of ADHD. This study investigates the predictors of postural stability in children with ADHD considering the covariant factors of age, gender, and comorbidities.

METHOD

A total of 103 children with ADHD are studied using Poor Postural Stability Questionnaire filled out by their parents.

RESULTS

Linear regression analysis indicates that only oppositional-defiant behavior score is the predictor of seeking-movement subscale score. ADHD type does not predict the score of avoiding-postural-instability subscale, whereas separation anxiety score did so.

CONCLUSION

ADHD subtypes do not have distinct clinical profiles of the balance problems. Postural stability in children with ADHD depends on the comorbid psychiatric disorders rather than ADHD subtypes.

Are balance problems connected to reading speed or the familial risk of dyslexia?

AIM

The aim of this study was to examine the connection between balance problems and reading speed in children with and without a familial risk of dyslexia by controlling for the effects of attention, hyperactivity, and cognitive and motor functioning.

METHOD

The prevalence of balance problems was studied in 94 children (48 females, 46 males) with a familial risk of dyslexia (at-risk group) and 85 children (38 females, 47 males) without a risk of dyslexia (comparison group). Further, the relationships between balance problems (at age 8y 6mo), reading proficiency (at age 9y), attention-deficit-hyperactivity disorder (at age 8y), and cognitive (at age 8y 6mo) and motor functioning (at age 6y 6mo) were examined. Inclusion criteria for the at-risk group were that at least one parent had a confirmed reading problem and one or more of the parents' close relatives also had a reading problem. The Good Balance System was used to assess static standing balance, word-list and text reading tasks were used to measure reading proficiency. The Behavioural Assessment System for Children - Parent Rating Scale was used to assess attention-deficit-hyperactivity disorder, the Wechsler Intelligence Scale for Children was used to assess cognitive functioning, and the Movement Assessment Battery for Children was used to measure motor functioning.

RESULTS

Balance (F((1,177)) =4.82; p=0.029; =0.027) and reading (F((1,176)) =11.95; p=0.001; =0.064) problems were more common in the at-risk group than in the comparison group. Furthermore, attention, hyperactivity, IQ, and motor functioning were not related to balance problems. However, attention (F((1,154)) =10.80; p=0.001; =0.066) and IQ (F((1,170)) =22.08; p<0.001; =0.115) were individually connected to reading speed.

INTERPRETATION

Balance problems alone could not produce any differences in reading skills. Instead, both balance problems and reduced reading skills were mainly associated separately with a familial risk of dyslexia. This indicates that there may be a shared genetic mechanism between balance and reading problems.

Time perception, phonological skills and executive function in children with dyslexia and/or ADHD symptoms

BACKGROUND

Deficits in time perception (the ability to judge the duration of time intervals) have been found in children with both attention-deficit/hyperactivity disorder (ADHD) and dyslexia. This paper investigates time perception, phonological skills and executive functions in children with dyslexia and/or ADHD symptoms (AS).

METHOD

Children with dyslexia-only (n = 17), AS-only (n = 17), comorbid dyslexia+AS (n = 25), and typically developing controls (n = 42), matched for age and non-verbal ability, were assessed on measures of phonological skills, executive function and time perception (duration discrimination and time reproduction).

RESULTS

Children with dyslexia were impaired on measures of phonological skill and duration discrimination compared to children without dyslexia (though problems on duration discrimination appeared to be attributable to mild symptoms of inattention in this group). In contrast, children with AS exhibited impairments on measures of both time perception and executive function compared to children without AS. Children with dyslexia+AS showed an additive combination of the deficits associated with dyslexia-only and AS-only.

CONCLUSIONS

Dyslexia and AS appear to be associated with distinct patterns of cognitive deficit, which are present in combination in children with dyslexia+AS.

Striking the right balance: motor difficulties in children and adults with dyslexia

Balance difficulties are an enduring feature of dyslexia research, however results have been inconsistent. We propose that between-study heterogeneity may be attributable to variability in balance tasks, balance measurement, participant age, and inclusion of comorbid disorders such as ADHD. This study attempted to clarify these issues, employing quantitative, continuous measures of balance and blindfolded balance, and using both adult and child participants without comorbid ADHD. Eighty-seven individuals participated: dyslexic adults (n = 17), matched adult controls (n = 30), dyslexic children (n = 16) and matched child controls (n = 24). The study found significant balance deficits for the child dyslexic group in the eyes-open task and a result approaching significance in the blindfolded task. By contrast, the adult dyslexic group showed significant deficits in the blindfolded task only. This result is interpreted in terms of lack of sensitivity of the non-blindfolded balance task for adults, owing to ceiling effects. This highlights the need for the use of age-appropriate tests, and may explain some of the heterogeneity in the literature. It is concluded that there is a significant incidence of balance difficulties in children and adults with dyslexia, even for those without comorbid attention deficit.

Dyslexia in regular orthographies: manifestation and causation

This article summarizes our research on the manifestation of dyslexia in German and on cognitive deficits, which may account for the severe reading speed deficit and the poor orthographic spelling performance that characterize dyslexia in regular orthographies. An only limited causal role of phonological deficits (phonological awareness, phonological STM, and rapid naming) for the emergence of reading fluency and spelling deficits is inferred from two large longitudinal studies with assessments of phonology before learning to read. A review of our cross-sectional studies provides no support for several cognitive deficits (visual-attention deficit, magnocellular dysfunction, skill automatization deficit, and visual-sequential memory deficit), which were proposed as alternatives to the phonological deficit account. Finally, a revised version of the phonological deficit account in terms of a dysfunction in orthographic-phonological connectivity is proposed.

Gray matter volume changes following reading intervention in dyslexic children

Studies in children and adults with the reading disability developmental dyslexia have shown behavioral improvements after reading intervention. In another line of work, it has been shown that intensive training in a variety of cognitive and sensorimotor skills can result in changes in gray matter volume (GMV). This study examined changes in GMV following intensive reading intervention in children with dyslexia using voxel-based morphometry (VBM). Eleven dyslexic children underwent an eight week training focused on mental imagery, articulation and tracing of letters, groups of letters and words, which resulted in significant gains in reading skills. This was followed by an eight week null period (control) where no intervention was administered and no further significant gains in reading were observed. Structural scans were obtained before the intervention, after the intervention and after the null period. GMV increases between the first two time points were found in the left anterior fusiform gyrus/hippocampus, left precuneus, right hippocampus and right anterior cerebellum. However these areas did not change between time points two and three (control period), suggesting that the changes were specific to the intervention period. These results demonstrate for the first time that (1) training-induced changes in GMV can be observed in a pediatric sample and (2) reading improvements induced by intervention are accompanied by GMV changes.

Motor function and methylphenidate effect in children with attention deficit hyperactivity disorder

AIM

Hyperactivity, impulsivity and poor attention are the core problems of ADHD and central stimulant medication is the preferred treatment. Many children with ADHD also display motor problems. The present study investigated the presence of motor problems in subjects who showed positive response to central stimulants on ADHD symptoms, compared with non-responders.

METHOD

This is a retrospective study of 73 children diagnosed ADHD, aged 5-17 years, who had been assessed with parts of the 'Motor Function Neurological Assessment' (MFNU) and evaluated with regard to effect of central stimulant medication. The sample was divided into two subgroups based on the responses to methylphenidate: Medicine responders and Non medicine responders.

RESULTS

Stimulant responders showed significantly more motor problems than the non-responders on all sub-tests and on the total problem score of the MFNU. Motor problems were present both in younger (age 5-10 years) and older (11-17 years) stimulant responders. There were no gender differences in motor performance.

CONCLUSION

Our findings indicate that the probability of positive effect of central stimulants on core problems of ADHD is higher when motor problems are present in addition to ADHD symptoms, than when motor problems are absent.

A test of the cerebellar hypothesis of dyslexia in adequate and inadequate responders to reading intervention

The cerebellar hypothesis of dyslexia posits that cerebellar deficits are associated with reading disabilities and may explain why some individuals with reading disabilities fail to respond to reading interventions. We tested these hypotheses in a sample of children who participated in a grade 1 reading intervention study (n = 174) and a group of typically achieving children (n = 62). At posttest, children were classified as adequately responding to the intervention (n = 82), inadequately responding with decoding and fluency deficits (n = 36), or inadequately responding with only fluency deficits (n = 56). Based on the Bead Threading and Postural Stability subtests from the Dyslexia Screening Test-Junior, we found little evidence that assessments of cerebellar functions were associated with academic performance or responder status. In addition, we did not find evidence supporting the hypothesis that cerebellar deficits are more prominent for poor readers with "specific" reading disabilities (i.e., with discrepancies relative to IQ) than for poor readers with reading scores consistent with IQ. In contrast, measures of phonological awareness, rapid naming, and vocabulary were strongly associated with responder status and academic outcomes. These results add to accumulating evidence that fails to associate cerebellar functions with reading difficulties.

When all hypotheses are right: a multifocal account of dyslexia

Many hypotheses have been proposed about the brain underpinnings of developmental dyslexia, but none of them accommodates the variable deficits observed. To address the issue of anatomical deficits in dyslexia; total and partial volumes, lateralization indices (LI), and local gray matter volumes (LGMV) were measured. Analyses were performed in large samples of control and dyslexic subjects, and in correlation with their performance on phonological, reading, and spelling tests. Results indicate an absence of net differences in terms of volumes but significant continuities and discontinuities between groups in their correlations between LI, LGMV, and performances. Structural connectivity also highlighted correlations between areas showing (dis)continuities between control and dyslexic subjects. Overall, our data put forward the idea of a multifocal brain abnormalities in dyslexia with a major implication of the left superior temporal gyrus, occipital-temporal cortices, and lateral/medial cerebellum, which could account for the diverse deficits predicted by the different theories.

Children with attention deficit hyperactivity disorder have impaired balance function: involvement of somatosensory, visual, and vestibular systems

OBJECTIVES

To compare standing balance performance and sensory organization of balance control in children with attention deficit hyperactivity disorder (combined type) (ADHD-C) and typically developing children.

STUDY DESIGN

School-aged children (n = 43) with ADHD-C and 50 age- and sex-matched typically developing children participated in the study. Sensory organization of standing balance was evaluated using the Sensory Organization Test (SOT). In addition to the composite equilibrium score, somatosensory, vestibular, and visual ratios, which were indicators of the ability of the child to use information from the respective sensory systems to maintain balance, were computed. Multivariate analysis of covariance (MANCOVA) was used to compare the outcome variables between the 2 groups while controlling for physical activity level.

RESULTS

MANCOVA revealed that children with ADHD-C had significantly lower composite equilibrium scores (P < .001) and somatosensory (P = .029), vestibular (P = .037), and visual ratios (P = .001) than control children, by 10.3%, 2.1%, 15.6%, and 16.0%, respectively.

CONCLUSIONS

Children with ADHD-C had significant deficits in standing balance performance in all conditions that included a disruption of sensory signals. The visual system tends to be more involved in contributing to the balance deficits in children with ADHD-C than the somatosensory and vestibular systems.