Multimodal intervention in 8- to 13-year-old French dyslexic readers: Study protocol for a randomized multicenter controlled crossover trial.

BACKGROUND: Developmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual's cognitive profile as part of a longitudinal intervention study. METHODS: This multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an "intention-to-treat" analysis will be performed on the children who quit the trial before the end. DISCUSSION: The main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04028310. Registered on July 18, 2019.

Neural processing of vision and language in kindergarten is associated with prereading skills and predicts future literacy.

The main objective of this longitudinal study was to investigate the neural predictors of reading acquisition. For this purpose, we followed a sample of 54 children from the end of kindergarten to the end of second grade. Preliterate children were tested for visual symbol (checkerboards, houses, faces, written words) and auditory language processing (spoken words) using a passive functional magnetic resonance imaging paradigm. To examine brain-behavior relationships, we also tested cognitive-linguistic prereading skills at kindergarten age and reading performance of 48 of the same children 2 years later. Face-selective response in the bilateral fusiform gyrus was positively associated with rapid automatized naming (RAN). Response to both spoken and written words at preliterate age was negatively associated with RAN in the dorsal temporo-parietal language system. Longitudinally, neural response to faces in the ventral stream predicted future reading fluency. Here, stronger neural activity in inferior and middle temporal gyri at kindergarten age was associated with higher reading performance. Our results suggest that interindividual differences in the neural system of language and reading affect literacy acquisition and thus might serve as a marker for successful reading acquisition in preliterate children.

The dynamics of morphological processing in developing readers: A cross-linguistic masked priming study.

Empirical evidence from masked priming research shows that skilled readers can rapidly identify morphological structure in written language. However, comparatively little is known about how and when this skill is acquired in children. The current work investigated the developmental trajectory of morphological processing in a 2-year longitudinal study involving two large cohorts of German and French primary school children. The masked priming paradigm was used within an experimental design that allowed us to dissociate effects of (a) nonmorphological embedded word activation, (b) morpho-orthographic decomposition, and (c) morpho-semantics. Four priming conditions were used: affixed word (farmer-FARM), affixed nonword (farmity-FARM), nonaffixed nonword (farmald-FARM), and unrelated control (workald-FARM). The results revealed robust embedded word priming effects across both languages. However, morpho-orthographic and morpho-semantic effects were evident only in the French sample. These findings are discussed in the context of a theoretical framework that specifies the distinct roles played by embedded words and affixes, their distinct developmental trajectories, and how the intrinsic linguistic properties of a given language may affect morphological processing.

Orthographic consistency influences morphological processing in reading aloud: Evidence from a cross-linguistic study.

The present study investigated whether morphological processing in reading is influenced by the orthographic consistency of a language or its morphological complexity. Developing readers in Grade 3 and skilled adult readers participated in a reading aloud task in four alphabetic orthographies (English, French, German, Italian), which differ in terms of both orthographic consistency and morphological complexity. English is the least consistent, in terms of its spelling-to-sound relationships, as well as the most morphologically sparse, compared to the other three. Two opposing hypotheses were formulated. If orthographic consistency modulated the use of morphology in reading, readers of English should show more robust morphological processing than readers of the other three languages, because morphological units increase the reliability of spelling-to-sound mappings in the English language. In contrast, if the use of morphology in reading depended on the morphological complexity of a language, readers of French, German, and Italian should process morphological units in printed letter strings more efficiently than readers of English. Both developing and skilled readers of English showed greater morphological processing than readers of the other three languages. These results support the idea that the orthographic consistency of a language, rather than its morphological complexity, influences the extent to which morphology is used during reading. We explain our findings within the remit of extant theories of reading acquisition and outline their theoretical and educational implications.

Understanding Dyslexia Through Personalized Large-Scale Computational Models.

Learning to read is foundational for literacy development, yet many children in primary school fail to become efficient readers despite normal intelligence and schooling. This condition, referred to as developmental dyslexia, has been hypothesized to occur because of deficits in vision, attention, auditory and temporal processes, and phonology and language. Here, we used a developmentally plausible computational model of reading acquisition to investigate how the core deficits of dyslexia determined individual learning outcomes for 622 children (388 with dyslexia). We found that individual learning trajectories could be simulated on the basis of three component skills related to orthography, phonology, and vocabulary. In contrast, single-deficit models captured the means but not the distribution of reading scores, and a model with noise added to all representations could not even capture the means. These results show that heterogeneity and individual differences in dyslexia profiles can be simulated only with a personalized computational model that allows for multiple deficits.

Do Words Stink? Neural Reuse as a Principle for Understanding Emotions in Reading.

How do we understand the emotional content of written words? Here, we investigate the hypothesis that written words that carry emotions are processed through phylogenetically ancient neural circuits that are involved in the processing of the very same emotions in nonlanguage contexts. This hypothesis was tested with respect to disgust. In an fMRI experiment, it was found that the same region of the left anterior insula responded whether people observed facial expressions of disgust or whether they read words with disgusting content. In a follow-up experiment, it was found that repetitive TMS over the left insula in comparison with a control site interfered with the processing of disgust words to a greater extent than with the processing of neutral words. Together, the results support the hypothesis that the affective processes we experience when reading rely on the reuse of phylogenetically ancient brain structures that process basic emotions in other domains and species.

It's about time: revisiting temporal processing deficits in dyslexia.

Temporal processing in French children with dyslexia was evaluated in three tasks: a word identification task requiring implicit temporal processing, and two explicit temporal bisection tasks, one in the auditory and one in the visual modality. Normally developing children matched on chronological age and reading level served as a control group. Children with dyslexia exhibited robust deficits in temporal tasks whether they were explicit or implicit and whether they involved the auditory or the visual modality. First, they presented larger perceptual variability when performing temporal tasks, whereas they showed no such difficulties when performing the same task on a non-temporal dimension (intensity). This dissociation suggests that their difficulties were specific to temporal processing and could not be attributed to lapses of attention, reduced alertness, faulty anchoring, or overall noisy processing. In the framework of cognitive models of time perception, these data point to a dysfunction of the 'internal clock' of dyslexic children. These results are broadly compatible with the recent temporal sampling theory of dyslexia.

Automaticity of phonological and semantic processing during visual word recognition.

Reading involves activation of phonological and semantic knowledge. Yet, the automaticity of the activation of these representations remains subject to debate. The present study addressed this issue by examining how different brain areas involved in language processing responded to a manipulation of bottom-up (level of visibility) and top-down information (task demands) applied to written words. The analyses showed that the same brain areas were activated in response to written words whether the task was symbol detection, rime detection, or semantic judgment. This network included posterior, temporal and prefrontal regions, which clearly suggests the involvement of orthographic, semantic and phonological/articulatory processing in all tasks. However, we also found interactions between task and stimulus visibility, which reflected the fact that the strength of the neural responses to written words in several high-level language areas varied across tasks. Together, our findings suggest that the involvement of phonological and semantic processing in reading is supported by two complementary mechanisms. First, an automatic mechanism that results from a task-independent spread of activation throughout a network in which orthography is linked to phonology and semantics. Second, a mechanism that further fine-tunes the sensitivity of high-level language areas to the sensory input in a task-dependent manner.

Spatiotemporal Dynamics of Morphological Processing in Visual Word Recognition.

The spatiotemporal dynamics of morphological, orthographic, and semantic processing were investigated in a primed lexical decision task in French using magnetoencephalography (MEG). The goal was to investigate orthographic and semantic contributions to morphological priming and compare these effects with pure orthographic and semantic priming. The time course of these effects was analyzed in anatomically defined ROIs that were selected according to previous MEG and fMRI findings. The results showed that morphological processing was not localized in one specific area but distributed over a vast network that involved left inferior temporal gyrus, left superior temporal gyrus, left inferior frontal gyrus, and left orbitofrontal gyrus. Second, all morphological effects were specific, that is, in none of the ROIs could morphology effects be explained by pure orthographic or pure semantic overlap. Third, the ventral route was sensitive to both the orthographic and semantic "part" of the morphological priming effect in the M350 time window. Fourth, the earliest effects of morphology occurred in left superior temporal gyrus around 250 msec and reflected the semantic contribution to morphological facilitation. Together then, the present results show that morphological processing is not just an emergent property of processing form or meaning and that semantic contributions to morphological facilitation can occur as early as 250 msec in the left superior temporal gyrus.

Orthographic processing deficits in developmental dyslexia: Beyond the ventral visual stream.

Fast effortless reading has been associated with the Visual Word Form Area (VWFA), a region in the ventral visual stream that specializes in the recognition of letter strings. Several neuroimaging studies of dyslexia revealed an underactivation of this region. However, most of these studies used reading tasks and/or were carried out on adults. Given that fluent reading is severely impaired in dyslexics, any underactivation might simply reflect a well-established reading deficit in impaired readers and could be the consequence rather than the cause of dyslexia. Here, we designed a task that does not rely on reading per se but that tapped early visual orthographic processing that forms the basis of reading. Dyslexic children aged 8-12years and age-matched controls were asked to search for letters, digits, and symbols in 5-element strings (Experiment 1). This novel task was complemented by a classic task known to activate the VWFA, namely the passive viewing of pseudowords and falsefonts (Experiment 2). We found that in addition to significant group differences in the VWFA, dyslexic children showed a significant underactivation of the middle occipital gyrus (MOG) relative to the control group. Several areas in the MOG are known for their engagement in visuospatial processing, and it has been proposed that the MOG is necessary for ordering the symbols in unfamiliar strings. Our results suggest that the VWFA deficit might be secondary to an impairment of visuospatial processing in the MOG. We argue that efficient processing in MOG in the course of reading acquisition is critical for the development of effortless fast visual word recognition in the VWFA.