Neurobiological bases of reading disorder Part I: Etiological investigations

Universality and language specificity of brain reading networks: A developmental perspective

The development of reading networks across different languages and cultures provides an important window to address gene-culture interactions in brain functionality development. Previous meta-analyses have explored the neural correlates of reading in different languages with diverse orthographic transparencies. However, it remains unknown whether the neural topographic relationship of different languages varies when taking development into account. To address this issue, we conducted meta-analyses of neuroimaging studies with approaches of activation likelihood estimation and seed-based effect size mapping and focused on two highly contrasting languages, Chinese and English. The meta-analyses covered 61 studies of Chinese reading and 64 studies of English reading by native speakers. The brain reading networks of child and adult readers were further separately analyzed and compared to explore the developmental effects. The results revealed that the commonalities and differences in reading networks for Chinese and English were inconsistent between children and adults. In addition, the reading networks converged with development, and the effects of writing systems on brain function organizations were more salient in the initial stages of reading. An interesting finding was that the left inferior parietal lobule demonstrated increased effect sizes in adults compared with children in both Chinese and English reading, indicating a common developmental feature of reading mechanisms across the two languages. These findings provide new insights into the functional evolution and cultural modulation of brain reading networks. RESEARCH HIGHLIGHTS: Meta-analyses with approaches of activation likelihood estimation and seed-based effect size mapping were performed to evaluate the developmental characteristics of brain reading networks. The engagement of universal and language-specific reading networks was different between children and adults, and the reading networks converged with increased reading experience. Overall the middle/inferior occipital and inferior/middle frontal gyrus were specific to Chinese and the middle temporal, right inferior frontal gyrus were specific to English. The left inferior parietal lobule was engaged more in adults than children in Chinese and English reading, demonstrating a common developmental feature of reading mechanisms.

Joint exome and metabolome analysis in individuals with dyslexia: Evidence for associated dysregulations of olfactory perception and autoimmune functions

Dyslexia is a learning disability that negatively affects reading, writing, and spelling development at the word level in 5%-9% of children. The phenotype is variable and complex, involving several potential cognitive and physical concomitants such as sensory dysregulation and immunodeficiencies. The biological pathogenesis is not well-understood. Toward a better understanding of the biological drivers of dyslexia, we conducted the first joint exome and metabolome investigation in a pilot sample of 30 participants with dyslexia and 13 controls. In this analysis, eight metabolites of interest emerged (pyridoxine, kynurenic acid, citraconic acid, phosphocreatine, hippuric acid, xylitol, 2-deoxyuridine, and acetylcysteine). A metabolite-metabolite interaction analysis identified Krebs cycle intermediates that may be implicated in the development of dyslexia. Gene ontology analysis based on exome variants resulted in several pathways of interest, including the sensory perception of smell (olfactory) and immune system-related responses. In the joint exome and metabolite analysis, the olfactory transduction pathway emerged as the primary pathway of interest. Although the olfactory transduction and Krebs cycle pathways have not previously been described in dyslexia literature, these pathways have been implicated in other neurodevelopmental disorders including autism spectrum disorder and obsessive-compulsive disorder, suggesting the possibility of these pathways playing a role in dyslexia as well. Immune system response pathways, on the other hand, have been implicated in both dyslexia and other neurodevelopmental disorders.

Developmental dyslexia susceptibility genes DNAAF4, DCDC2, and NRSN1 are associated with brain function in fluently reading adolescents and young adults

Reading skills and developmental dyslexia, characterized by difficulties in developing reading skills, have been associated with brain anomalies within the language network. Genetic factors contribute to developmental dyslexia risk, but the mechanisms by which these genes influence reading skills remain unclear. In this preregistered study (https://osf.io/7sehx), we explored if developmental dyslexia susceptibility genes DNAAF4, DCDC2, NRSN1, and KIAA0319 are associated with brain function in fluently reading adolescents and young adults. Functional MRI and task performance data were collected during tasks involving written and spoken sentence processing, and DNA sequence variants of developmental dyslexia susceptibility genes previously associated with brain structure anomalies were genotyped. The results revealed that variation in DNAAF4, DCDC2, and NRSN1 is associated with brain activity in key language regions: the left inferior frontal gyrus, middle temporal gyrus, and intraparietal sulcus. Furthermore, NRSN1 was associated with task performance, but KIAA0319 did not yield any significant associations. Our findings suggest that individuals with a genetic predisposition to developmental dyslexia may partly employ compensatory neural and behavioral mechanisms to maintain typical task performance. Our study highlights the relevance of these developmental dyslexia susceptibility genes in language-related brain function, even in individuals without developmental dyslexia, providing valuable insights into the genetic factors influencing language processing.

Specific Learning Disorders (SLD) and Behavior Impairment: Comorbidity or Specific Profile?

INTRODUCTION

Specific Learning Disorder (SLD) is a neurodevelopmental disorder characterized by difficulties in perceiving and processing verbal and non-verbal information. It is usually accompanied by impaired academic skills leading to school dropout and emotional disturbances, resulting in significant distress and behavioral problems.

METHODS

A cognitive, academic, and emotional-behavioral assessment was performed at T0 and T1 in children and adolescents with SLD. Participants received psychotherapy and speech therapy treatment from T0 to T1.

RESULTS

In SLD, the most compromised cognitive functions were working memory and writing skills. An impact on academic abilities was found. Children and adolescents with SLD experience greater anxiety and depression levels compared to their control peers.

CONCLUSIONS

SLD may adversely influence psychological well-being. To counteract such a consequence, more specific cognitive and academic skill-oriented strategies should be taken into consideration.

Reading anxiety modulates the functional connectivity of the reading-related network during adult reading

Researchers have studied cognitive and linguistic skills in predicting reading abilities, but the impact of affective factors such as anxiety on reading at the neurobiological level is not well understood. Here, we used functional magnetic resonance imaging to investigate the neural correlates of reading anxiety in adult readers performing a semantic judgment task. The results showed that reading anxiety was significantly correlated with response time but not with accuracy. Neurobiologically, functional connectivity strength rather than activation level of semantic-related areas significantly predicted reading anxiety. Activation of regions (i.e., the right putamen and right precentral gyrus) external to the semantic-related areas positively correlated with reading anxiety levels. These findings suggest that reading anxiety influences adult reading by modulating functional connections of semantic-related areas and brain activation of semantic-unrelated areas. This study provides insights into the neural mechanisms underlying reading anxiety experienced by adult readers.

Functional preference of the left inferior parietal lobule to second language reading

Additional neural substance for reading in a second language has been reported by prior studies. However, to date, there has been little investigation into whether and how the brain's adaptation to a second language is induced by specific linguistic tasks or is a general effect during reading in a new language. To address this issue, our study investigated Chinese children learning English as a second language by combining cross-sectional and longitudinal Functional Magnetic Resonance Imaging (fMRI) studies. We compared brain activation across four reading tasks, orthographic tasks and phonological tasks in Chinese (the first language, L1) and English (the second language, L2). By comparing the activation pattern across languages, we observed greater activation in the left inferior parietal lobule (LIPL) in English compared to Chinese, suggesting a functional preference of the LIPL to L2. In addition, greater correlation between LIPL-related FC and L2 was mainly observed in the phonological task, indicating that LIPL could be associated with phonological processing. Moreover, a proportion of the children were enrolled in an 8-week phonological-based reading-training program. We observed significant functional plasticity of the LIPL elicited by this training program only in the English phonological task and not in the orthographic task, further substantiating that the additional requirements of the LIPL in L2 are mainly associated with phonological processing. The findings provide new insights into understanding the functional contribution of the LIPL to reading in a second language.

Functional and morphological correlates of developmental dyslexia: A multimodal investigation of the ventral occipitotemporal cortex

BACKGROUND AND PURPOSE

The ventral occipitotemporal cortex (vOT) is a region crucial for reading acquisition through selective tuning to printed words. Developmental dyslexia is a disorder of reading with underlying neurobiological bases often associated with atypical neural responses to printed words. Previous studies have discovered anomalous structural development and function of the vOT in individuals with dyslexia. However, it remains unclear if or how structural abnormalities relate to functional alterations.

METHODS

In this study, we acquired structural, functional (words and faces processing), and diffusion MRI data from 26 children with dyslexia (average age = 10.4 ± 2.0 years) and 14 age-matched typically developing readers (average age = 10.4 ± 1.6 years). Morphological indices of local gyrification, neurite density (i.e., dendritic arborization structure), and orientation dispersion (i.e., dendritic arborization orientation) were analyzed within the vOT region that showed preferential activation in typically developing readers for words (as compared to face stimuli).

RESULTS

The two cohorts diverged significantly in both functional and structural measures. Compared to typically developing controls, children with dyslexia did not show selectivity for words in the left vOT (contrast: words > false fonts). This lack of tuning to printed words was associated with greater neurite dispersion heterogeneity in the dyslexia cohort, but similar neurite density. These group differences were not present in the homologous contralateral area, the right vOT.

CONCLUSIONS

Our findings provide new insight into the neurobiology of the lack of vOT word tuning in dyslexia by linking behavior, alterations in functional activation, and neurite organization.

Decoding the role of the cerebellum in the early stages of reading acquisition

Numerous studies have consistently reported functional activation of the cerebellum during reading tasks, especially in the right cerebellar hemisphere. However, it remains unclear whether this region is also involved in reading during the earliest stages of reading acquisition. Here, we investigated whether and how the cerebellum contributes to reading acquisition. We tested 80 5-6-year-old kindergarteners, who performed a visual word matching task during which functional MRI (fMRI) data were collected. We found that bilateral cerebellar hemispheres were significantly activated during visual word processing. Moreover, activation of left cerebellar lobule VII extending to lobule VIII negatively and significantly correlated with current reading ability, whereas activation of right cerebellar lobule VII extending to lobule VIII significantly and positively correlated with future reading ability. Functional decoding via functional connectivity patterns further revealed that left and right cerebellar lobules connected with different cerebral cortex regions. Our results suggest a division of labor between the left and right cerebellar lobules in beginning readers.

Altered gray matter development in pre-reading children with a family history of reading disorder

Reading disorders are common in children and can impact academic success, mental health, and career prospects. Reading is supported by network of interconnected left hemisphere brain regions, including temporo-parietal, occipito-temporal, and inferior-frontal circuits. Poor readers often show hypoactivation and reduced gray matter volumes in this reading network, with hyperactivation and increased volumes in the posterior right hemisphere. We assessed gray matter development longitudinally in pre-reading children aged 2-5 years using magnetic resonance imaging (MRI) (N = 32, 110 MRI scans; mean age: 4.40 ± 0.77 years), half of whom had a family history of reading disorder. The family history group showed slower proportional growth (relative to total brain volume) in the left supramarginal and inferior frontal gyri, and faster proportional growth in the right angular, right fusiform, and bilateral lingual gyri. This suggests delayed development of left hemisphere reading areas in children with a family history of dyslexia, along with faster growth in right homologues. This alternate development pattern may predispose the brain to later reading difficulties and may later manifest as the commonly noted compensatory mechanisms. The results of this study further shows our understanding of structural brain alterations that may form the neurological basis of reading difficulties.

Functional connectivity alterations associated with literacy difficulties in early readers

The link between literacy difficulties and brain alterations has been described in depth. Resting-state fMRI (rs-fMRI) has been successfully applied to the study of intrinsic functional connectivity (iFc) both in dyslexia and typically developing children. Most related studies have focused on the stages from late childhood into adulthood using a seed to voxel approach. Our study analyzes iFc in an early childhood sample using the multivariate pattern analysis. This facilitates a hypothesis-free analysis and the possible identification of abnormal functional connectivity patterns at a whole brain level. Thirty-four children with literacy difficulties (LD) (7.1 ± 0.69 yr.) and 30 typically developing children (TD) (7.43 ± 0.52 yr.) were selected. Functional brain connectivity was measured using an rs-fMRI acquisition. The LD group showed a higher iFc between the right middle frontal gyrus (rMFG) and the default mode network (DMN) regions, and a lower iFc between the rMFG and both the bilateral insular cortex and the supramarginal gyrus. These results are interpreted as a DMN on/off routine malfunction in the LD group, which suggests an alteration of the task control network regulating DMN activity. In the LD group, the posterior cingulate cortex also showed a lower iFc with both the middle temporal poles and the fusiform gyrus. This could be interpreted as a failure in the integration of information between brain regions that facilitate reading. Our results show that children with literacy difficulties have an altered functional connectivity in their reading and attentional networks at the beginning of the literacy acquisition. Future studies should evaluate whether or not these alterations could indicate a risk of developing dyslexia.

Developmental dyslexia: A new look at clinical features and brain mechanisms

Developmental dyslexia is the commonest "specific learning disorder" (DSM-5) or "developmental learning disorder with impairment in reading" (ICD-11). This impairment in reading acquisition is related to a defect in the installation of cognitive precursors necessary to master the grapheme-phoneme conversion. Its origin is largely genetic, but many environmental factors seem capable of modulating symptom intensity. Three types of presentation, roughly equal in occurrence, are useful to distinguish according to the associated disorders (language, attentional, and/or motor coordination), thus suggesting, at least in part, potentially different mechanisms at their origin. In adolescence and adulthood the clinical presentation tends to bear a more uniform pattern, covering a large range of severity depending on each person's ability to compensate for their deficit. Research has demonstrated dysfunction of specific brain areas during reading-related tasks (using fMRI), essentially in the left cerebral hemisphere, but also atypical patterns of connectivity (using diffusion imaging), further supplemented by functional connectivity studies at rest. The current therapeutic recommendations emphasize the need for multidisciplinary care, giving priority, depending on the clinical form, to the language, psychomotor, or neuropsychologic aspects of rehabilitation. Various training methods whose effectiveness has been scientifically tested are reviewed, emphasizing those exploiting the hypothesis of a lack of intermodal connectivity between separate cognitive systems.

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

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

Anxiety and Attentional Bias in Children with Specific Learning Disorders

Children with specific learning disorders (SLDs) face a unique set of socio-emotional challenges as a result of their academic difficulties. Although a higher prevalence of anxiety in children with SLD is often reported, there is currently no research on cognitive mechanisms underlying this anxiety. One way to elucidate these mechanisms is to investigate attentional bias to threatening stimuli using a dot-probe paradigm. Our study compared children ages 9-16 with SLD (n = 48) to typically-developing (TD) controls (n = 33) on their attentional biases to stimuli related to general threats, reading, and stereotypes of SLD. We found a significant threat bias away from reading-related stimuli in the SLD, but not TD group. This attentional bias was not observed with the general threat and stereotype stimuli. Further, children with SLD reported greater anxiety compared to TD children. These results suggest that children with SLD experience greater anxiety, which may partially stem from reading specifically. The finding of avoidance rather than vigilance to reading stimuli indicates the use of more top-down attentional control. This work has important implications for therapeutic approaches to anxiety in children with SLD and highlights the need for attention to socio-emotional difficulties in this population. Future research is needed to further investigate the cognitive aspects of socio-emotional difficulties in children with SLD, as well as how this may impact academic outcomes.

Attentional Processes in Children With Attentional Problems or Reading Difficulties as Revealed Using Brain Event-Related Potentials and Their Source Localization

Visual attention-related processes include three functional sub-processes: alerting, orienting, and inhibition. We examined these sub-processes using reaction times, event-related potentials (ERPs), and their neuronal source activations during the Attention Network Test (ANT) in control children, attentional problems (AP) children, and reading difficulties (RD) children. During the ANT, electroencephalography was measured using 128 electrodes on three groups of Finnish sixth-graders aged 12–13 years (control = 77; AP = 15; RD = 23). Participants were asked to detect the direction of a middle target fish within a group of five fish. The target stimulus was either preceded by a cue (center, double, or spatial), or without a cue, to manipulate the alerting and orienting sub-processes of attention. The direction of the target fish was either congruent or incongruent in relation to the flanker fish, thereby manipulating the inhibition sub-processes of attention. Reaction time performance showed no differences between groups in alerting, orienting, and inhibition effects. The group differences in ERPs were only found at the source level. Neuronal source analysis in the AP children revealed a larger alerting effect (double-cued vs. non-cued target stimuli) than control and RD children in the left occipital lobe. Control children showed a smaller orienting effect (spatially cued vs. center-cued target stimuli) in the left occipital lobe than AP and RD children. No group differences were found for the neuronal sources related to the inhibition effect. The neuronal activity differences related to sub-processes of attention in the AP and RD groups suggest different underlying mechanisms for attentional and reading problems.

Atypical gray matter in children with dyslexia before the onset of reading instruction

Many studies have focused on neuroanatomical anomalies in dyslexia, yet primarily in school-aged children and adults. In the present study, we investigated gray matter surface area and cortical thickness at the pre-reading stage in a cohort of 54 children, 31 with a family risk for dyslexia and 23 without a family risk for dyslexia, of whom 16 children developed dyslexia. Surface-based analyses in the core regions of the reading network in the left hemisphere and in the corresponding right hemispheric regions were performed in FreeSurfer. Results revealed that pre-readers who develop dyslexia show reduced surface area in bilateral fusiform gyri. In addition, anomalies related to a family risk for dyslexia, irrespectively of later reading ability, were observed in the area of the bilateral inferior and middle temporal gyri. Differences were apparent in surface area, as opposed to cortical thickness. Results indicate that the neuroanatomical anomalies, since they are observed in the pre-reading phase, are not the consequence of impoverished reading experience.

Global gray matter morphometry differences between children with reading disability, ADHD, and comorbid reading disability/ADHD

Extensive, yet disparate, research exists elucidating structural anomalies in individuals with Reading Disability (RD) or ADHD. Despite ADHD and RD being highly comorbid, minimal research has attempted to determine shared patterns of morphometry between these disorders. In addition, there is no published research examining the morphometry of comorbid RD and ADHD (RD/ADHD). Hence, we conducted voxel-based morphometry on the MRI scans of 106 children, ages 8-12 years, with RD, ADHD, or RD/ADHD, and typically developing controls. We found right caudate and superior frontal regions in both RD and ADHD, along with areas specific to RD and to ADHD that are consistent with current theories on these disorders. Perhaps most importantly, we found a potential neurobiological substrate for RD/ADHD. Further, our findings illustrate both shared and specific contributors to RD/ADHD, supporting two current theories on the comorbidity of RD and ADHD, thereby facilitating future work on potential etiologies of RD/ADHD.

Is Dyslexia a Brain Disorder?

Specific word reading difficulty, commonly termed ‘developmental dyslexia’, refers to the low end of the word reading skill distribution but is frequently considered to be a neurodevelopmental disorder. This term implies that brain development is thought to be disrupted, resulting in an abnormal and dysfunctional brain. We take issue with this view, pointing out that there is no evidence of any obvious neurological abnormality in the vast majority of cases of word reading difficulty cases. The available relevant evidence from neuroimaging studies consists almost entirely of correlational and group-differences studies. However, differences in brains are certain to exist whenever differences in behavior exist, including differences in ability and performance. Therefore, findings of brain differences do not constitute evidence for abnormality; rather, they simply document the neural substrate of the behavioral differences. We suggest that dyslexia is best viewed as one of many expressions of ordinary ubiquitous individual differences in normal developmental outcomes. Thus, terms such as “dysfunctional” or “abnormal” are not justified when referring to the brains of persons with dyslexia.

The Importance of the Left Occipitotemporal Cortex in Developmental Dyslexia

Purpose of Review

Developmental dyslexia is characterized by an impaired acquisition of fluent and skilled reading ability. Numerous studies have explored the neural correlates of this neurodevelopmental disorder, with most classic accounts strongly focussing on left temporoparietal regions. We will review recent findings from structural and functional MRI studies that suggest a more important role of occipitotemporal cortex abnormalities in dyslexia.

Recent Findings

Recent findings highlight the role of the occipitotemporal cortex which exhibits functional as well as structural abnormalities in dyslexic readers and in children at risk for dyslexia and suggest a more central role for the occipitotemporal cortex in the pathophysiology of dyslexia.

Summary

We demonstrate the importance of the occipitotemporal cortex in for understanding impaired reading acquisition and point out how future research might enhance our understanding of functional and structural impairments in the reading network via large-scale data analysis approaches.

Recognizing Psychiatric Comorbidity With Reading Disorders

Reading disorder (RD), a specific learning disorder (SLD) of reading that includes impairment in word reading, reading fluency, and/or reading comprehension, is common in the general population but often is not comprehensively understood or assessed in mental health settings. In education settings, comorbid mental and associated disorders may be inadequately integrated into intervention plans. Assessment and intervention for RD may be delayed or absent in children with frequently co-occurring mental disorders not fully responding to treatment in both school and mental health settings. To address this oversight, this review summarizes current knowledge regarding RDs and common comorbid or co-occurring disorders that are important for mental health and school settings. We chose to highlight RD because it is the most common SLD, and connections to other often comorbid disorders have been more thoroughly described in the literature. Much of the literature we describe is on decoding-based RD (or developmental dyslexia) as it is the most common form of RD. In addition to risk for academic struggle and social, emotional, and behavioral problems, those with RD often show early evidence of combined or intertwined Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition childhood disorders. These include attention deficit hyperactivity disorder, anxiety and depression, disruptive, impulse-control, and conduct disorders, autism spectrum disorders, and other SLDs. The present review highlights issues and areas of controversy within these comorbidities, as well as directions for future research. An interdisciplinary, integrated approach between mental health professionals and educators can lead to comprehensive and targeted treatments encompassing both academic and mental health interventions. Such targeted treatments may contribute to improved educational and health-related outcomes in vulnerable youth. While there is a growing research literature on this association, more studies are needed of when to intervene and of the early and long-term benefits of comprehensive intervention.