Reading disorders in children

Understanding the biological basis of dyslexia at a neural systems level

We examined the naming speed performance of 18 typically achieving and 16 dyslexic adults while simultaneously recording eye movements, articulations and fMRI data. Naming speed tasks, which require participants to name a list of letters or objects, have been proposed as a proxy for reading and are thought to recruit similar reading networks in the left hemisphere of the brain as more complex reading tasks. We employed letter and object naming speed tasks, with task manipulations to make the stimuli more or less phonologically and/or visually similar. Compared to typically achieving readers, readers with dyslexia had a poorer behavioural naming speed task performance, longer fixation durations, more regressions and increased activation in areas of the reading network in the left-hemisphere. Whereas increased network activation was positively associated with performance in dyslexics, it was negatively related to performance in typically achieving readers. Readers with dyslexia had greater bilateral activation and recruited additional regions involved with memory, namely the amygdala and hippocampus; in contrast, the typically achieving readers additionally activated the dorsolateral prefrontal cortex. Areas within the reading network were differentially activated by stimulus manipulations to the naming speed tasks. There was less efficient naming speed behavioural performance, longer fixation durations, more regressions and increased neural activity when letter stimuli were both phonologically and visually similar. Discussion focuses on the differences in activation within the reading network, how they are related to behavioural task differences, and how progress in furthering the understanding of the relationship between behavioural performance and brain activity can change the overall trajectories of children with reading difficulties by contributing to both early identification and remediation processes.

An Extended Method for Saccadic Eye Movement Measurements Using a Head-Mounted Display

Saccadic eye movementis an important ability in our daily life and is especially important in driving and sports. Traditionally, the Developmental Eye Movement (DEM) test and the King-Devick (K-D) test have been used to measure saccadic eye movement, but these only involve measurements with "adjusted time". Therefore, a different approach is required to obtain the eye movement speed and reaction rate in detail, as some are rapid eye movements, while others are slow actions, and vice versa. This study proposed a extended method that can acquire the "rest time" and "transfer time", as well as the "adjusted time", by implementing a virtual reality-based DEM test, using a FOVE virtual reality (VR) head-mounted display, equipped with an eye-tracking module. This approach was tested in 30 subjects with normal vision and no ophthalmologic disease by using a 2-diopter (50-cm) distance. This allowed for measurement of the "adjusted time" and the "rest time" for focusing on each target number character, the "transfer time" for moving to the next target number character, and recording of the gaze-tracking log. The results of this experiment showed that it was possible to analyze more parameters of the saccadic eye movement with the proposed method than with the traditional methods.

Examining the neural and cognitive processes that underlie reading through naming speed tasks

We combined fMRI with eye tracking and speech recording to examine the neural and cognitive mechanisms that underlie reading. To simplify the study of the complex processes involved during reading, we used naming speed (NS) tasks (also known as rapid automatized naming or RAN) as a focus for this study, in which average reading right-handed adults named sets of stimuli (letters or objects) as quickly and accurately as possible. Due to the possibility of spoken output during fMRI studies creating motion artifacts, we employed both an overt session and a covert session. When comparing the two sessions, there were no significant differences in behavioral performance, sensorimotor activation (except for regions involved in the motor aspects of speech production) or activation in regions within the left-hemisphere-dominant neural reading network. This established that differences found between the tasks within the reading network were not attributed to speech production motion artifacts or sensorimotor processes. Both behavioral and neuroimaging measures showed that letter naming was a more automatic and efficient task than object naming. Furthermore, specific manipulations to the NS tasks to make the stimuli more visually and/or phonologically similar differentially activated the reading network in the left hemisphere associated with phonological, orthographic and orthographic-to-phonological processing, but not articulatory/motor processing related to speech production. These findings further our understanding of the underlying neural processes that support reading by examining how activation within the reading network differs with both task performance and task characteristics.

Oculomotor rehabilitation in children with dyslexia

Background: Dyslexia is the most common learning disorder. Visual and oculomotor deficits in dyslexic children have been reported. The purpose of this study was to measure oculomotor parameters and analyze the effect of oculomotor rehabilitation strategies on dyslexia. Methods: Binocular eye movements were recorded by oculomotor subtype of videonystagmography (VNG) testing on 30 children with dyslexia and 20 typical reader children (aged 8-12) in both genders. Dyslexic children were diagnosed with DSM-V scale by experts in reading disorder centers. We studied those children with developmental dyslexia, who had deficits in eye movements recording. Dyslexic children were divided into 2 groups of case and control. Oculomotor rehabilitation (including fixation, saccade, and tracking training) was performed in case group for 1 hour, twice weekly for 8 weeks. Before the intervention, results of oculomotor tests were compared between 3 groups (healthy, case, and control). Then, to analyze the effect of the intervention, results of oculomotor tests were compared between case and control groups in pre- and post- intervention stage. Data were analyzed by independent and paired samples t tests, ANOVA, and repeated measures tests in SPSS v. 21. Results: There were significant differences in oculomotor characteristics of dyslexic children in comparison with those reported in typical children. Oculomotor rehabilitation intervention had a positive effect on improvement of oculomotor responses and eye movements in dyslexic children. Moreover, there was no statistically significant difference between dyslexic children and non-dyslexic children in oculomotor skills after the training. Conclusion: Our results showed the positive effects of oculomotor rehabilitation on eye movements. Primary oculomotor assessment in dyslexic children and early use of oculomotor rehabilitation combined with other treatments are highly recommended.

Pediatric ophthalmology and childhood reading difficulties: Overview of reading development and assessments for the pediatric ophthalmologist

Reading difficulties are common in the pediatric population, and large socioeconomic disparities exist. In the United States 46% of white children achieved expected reading proficiency by the end of fourth grade, while only 21% of Hispanic and 18% of African American children were reading at the expected level. Reading is an involved cognitive process with many subskills; likewise, development of reading proficiency is a complex and continuous process. Failure to achieve reading proficiency or even early difficulty with reading can affect a child's academic performance for years to come. Some studies suggest reading proficiency may be related to later success in life. Although many problems with reading are not related to vision, a vision assessment is recommended for children with reading difficulties and a suspected vision problem. The process of reading development as well as the varied educational assessments of reading are presented here for pediatric ophthalmologists.

Eye Movements and Articulations During a Letter Naming Speed Task

Naming speed (NS) refers to how quickly and accurately participants name a set of familiar stimuli (e.g., letters). NS is an established predictor of reading ability, but controversy remains over why it is related to reading. We used three techniques (stimulus manipulations to emphasize phonological and/or visual aspects, decomposition of NS times into pause and articulation components, and analysis of eye movements during task performance) with three groups of participants (children with dyslexia, ages 9-10; chronological-age [CA] controls, ages 9-10; reading-level [RL] controls, ages 6-7) to examine NS and the NS-reading relationship. Results indicated (a) for all groups, increasing visual similarity of the letters decreased letter naming efficiency and increased naming errors, saccades, regressions (rapid eye movements back to letters already fixated), pause times, and fixation durations; (b) children with dyslexia performed like RL controls and were less efficient, had longer articulation times, pause times, fixation durations, and made more errors and regressions than CA controls; and (c) pause time and fixation duration were the most powerful predictors of reading. We conclude that NS is related to reading via fixation durations and pause times: Longer fixation durations and pause times reflect the greater amount of time needed to acquire visual/orthographic information from stimuli and prepare the correct response.

Impaired Oculomotor Behavior of Children with Developmental Dyslexia in Antisaccades and Predictive Saccades Tasks

Analysis of eye movement patterns during tracking tasks represents a potential way to identify differences in the cognitive processing and motor mechanisms underlying reading in dyslexic children before the occurrence of school failure. The current study aimed to evaluate the pattern of eye movements in antisaccades, predictive saccades and visually guided saccades in typical readers and readers with developmental dyslexia. The study included 30 children (age M = 11; SD = 1.67), 15 diagnosed with developmental dyslexia (DG) and 15 regular readers (CG), matched by age, gender and school grade. Cognitive assessment was performed prior to the eye-tracking task during which both eyes were registered using the Tobii® 1750 eye-tracking device. The results demonstrated a lower correct antisaccades rate in dyslexic children compared to the controls (p < 0.001, DG = 25%, CC = 37%). Dyslexic children also made fewer saccades in predictive latency (p < 0.001, DG = 34%, CG = 46%, predictive latency within −300–120 ms with target as 0 point). No between-group difference was found for visually guided saccades. In this task, both groups showed shorter latency for right-side targets. The results indicated altered oculomotor behavior in dyslexic children, which has been reported in previous studies. We extend these findings by demonstrating impaired implicit learning of target's time/position patterns in dyslexic children.

Reading networks in children with dyslexia compared to children with ocular motility disturbances revealed by fMRI

Key PointsDyslexia is a neurological disorder with a genetic origin, but the underlying biological and cognitive causes are still being investigated.This study compares the brain activation pattern while reading in Spanish, a semitransparent language, in three groups of children: typically developing readers, dyslexic readers and readers with functional monocular vision.Based on our results Dyslexia would be a neurological disorder not related to vision impairments and would require a multidisciplinary treatment based on improving phonological awareness and language development. Developmental dyslexia is a neurological disorder the underlying biological and cognitive causes of which are still being investigated, a key point, because the findings will determine the best therapeutic approach to use. Using functional magnetic resonance imaging, we studied the brain activation pattern while reading in the language-related cortical areas from the two reading routes, phonological and orthographic, and the strength of their association with reading scores in 66 Spanish-speaking children aged 9-12 years divided into three groups: typically developing readers (controls), dyslexic readers and readers with monocular vision due to ocular motility disorders but with normal reading development, to assess whether (or not) the neuronal network for reading in children with dyslexia has similarities with that in children with impaired binocular vision due to ocular motility disorders. We found that Spanish-speaking children with dyslexia have a brain circuit for reading that differs from that in children with monocular vision. Individuals with dyslexia tend to hypoactivate some of the language-related areas in the left hemisphere engaged by the phonological route, especially the visual word form area and left Wernicke's area, and try to compensate this deficit by activating language-related areas related to the orthographic route, such as the anterior part of the visual word form area and the posterior part of both middle temporal gyri. That is, they seem to compensate for impairment in the phonological route through orthographic routes of both hemispheres. Our results suggest that ocular motility disturbances do not play a causal role in dyslexia. Dyslexia seems to be a neurological disorder that is unrelated to vision impairments and requires early recognition and multidisciplinary treatment, based on improving phonological awareness and language development, to achieve the best possible outcome.

Colors, colored overlays, and reading skills

In this article, we are concerned with the role of colors in reading written texts. It has been argued that colored overlays applied above written texts positively influence both reading fluency and reading speed. These effects would be particularly evident for those individuals affected by the so called Meares-Irlen syndrome, i.e., who experience eyestrain and/or visual distortions – e.g., color, shape, or movement illusions – while reading. This condition would interest the 12–14% of the general population and up to the 46% of the dyslexic population. Thus, colored overlays have been largely employed as a remedy for some aspects of the difficulties in reading experienced by dyslexic individuals, as fluency and speed. Despite the wide use of colored overlays, how they exert their effects has not been made clear yet. Also, according to some researchers, the results supporting the efficacy of colored overlays as a tool for helping readers are at least controversial. Furthermore, the very nature of the Meares-Irlen syndrome has been questioned. Here we provide a concise, critical review of the literature.

Convergence insufficiency and vision therapy

There is no standard meaning of the term "vision therapy", and for this reason it is often a controversial topic between some members of the ophthalmic and optometric community. Most pediatric ophthalmologists avoid using the term because it is nonspecific. Convergence Insufficiency (CI) is a binocular visual problem that causes problems and symptoms with near fixation. There is consensus among eye care professionals that convergence therapy is effective in treating CI. Convergence therapy is not effective in treating learning disabilities, but can sometimes relieve symptoms that might be a barrier to reading.

The washington metropolitan pediatric vision screening quality control assessment

Objective. To ascertain if parents are familiar with current recommendations on pediatric vision screening and to assess their knowledge of the roles that pediatricians, ophthalmologists and optometrists have in this screening process. Methods. A survey was targeted at parents to determine what the general public understands regarding vision screening. Results. The survey was conducted from January–May 2010. One hundred fifty six persons responded. Over one-third did not know the difference between eye care specialists. Many believed opticians and optometrists receive medical school training. Over forty percent incorrectly identified the recommended visual acuity testing age. A large discrepancy existed regarding who should perform pediatric eye exams. Most agreed a failed screening warranted follow-up, but there was not a uniform opinion as to when to seek care. The majority of respondents understood amblyopia should be treated at least before age ten; although nine percent believed amblyopia could be treated at any age. Discussion. There is a significant lack of understanding of the current screening recommendations, difference between eye care professionals, and the importance of early treatment of amblyopia. Conclusions. Many parents do not understand the potential detrimental consequences of delayed care in the event their child fails a vision screening.

Learning disabilities, dyslexia, and vision

Learning disabilities constitute a diverse group of disorders in which children who generally possess at least average intelligence have problems processing information or generating output. Their etiologies are multifactorial and reflect genetic influences and dysfunction of brain systems. Reading disability, or dyslexia, is the most common learning disability. It is a receptive language-based learning disability that is characterized by difficulties with decoding, fluent word recognition, rapid automatic naming, and/or reading-comprehension skills. These difficulties typically result from a deficit in the phonologic component of language that makes it difficult to use the alphabetic code to decode the written word. Early recognition and referral to qualified professionals for evidence-based evaluations and treatments are necessary to achieve the best possible outcome. Because dyslexia is a language-based disorder, treatment should be directed at this etiology. Remedial programs should include specific instruction in decoding, fluency training, vocabulary, and comprehension. Most programs include daily intensive individualized instruction that explicitly teaches phonemic awareness and the application of phonics. Vision problems can interfere with the process of reading, but children with dyslexia or related learning disabilities have the same visual function and ocular health as children without such conditions. Currently, there is inadequate scientific evidence to support the view that subtle eye or visual problems cause or increase the severity of learning disabilities. Because they are difficult for the public to understand and for educators to treat, learning disabilities have spawned a wide variety of scientifically unsupported vision-based diagnostic and treatment procedures. Scientific evidence does not support the claims that visual training, muscle exercises, ocular pursuit-and-tracking exercises, behavioral/perceptual vision therapy, "training" glasses, prisms, and colored lenses and filters are effective direct or indirect treatments for learning disabilities. There is no valid evidence that children who participate in vision therapy are more responsive to educational instruction than children who do not participate.

Another joint statement regarding learning disabilities, dyslexia, and vision--a rebuttal

Several medical organizations have published yet another joint statement trivializing vision therapy and vision disorders in the learning-disabled population. A review of the references in the joint statement as well as other references find that the joint statement is misleading because of inappropriate citations and selected references, as was the case with previous joint statements. The most current joint statement ignores the results of evidence-based research and makes recommendations regarding the treatment of convergence insufficiency that have no scientific validity. Ophthalmology should not allow professional rivalry to cloud its judgment regarding optometry's involvement in the diagnosis and treatment of learning-related vision problems.