Action video games normalise the phonemic awareness in pre-readers at risk for developmental dyslexia.

Action video-games (AVGs) could improve reading efficiency, enhancing not only visual attention but also phonological processing. Here we tested the AVG effects upon three consolidated language-based predictors of reading development in a sample of 79 pre-readers at-risk and 41 non-at-risk for developmental dyslexia. At-risk children were impaired in either phonemic awareness (i.e., phoneme discrimination task), phonological working memory (i.e., pseudoword repetition task) or rapid automatized naming (i.e., RAN of colours task). At-risk children were assigned to different groups by using an unequal allocation randomization: (1) AVG (n = 43), (2) Serious Non-Action Video Game (n = 11), (3) treatment-as-usual (i.e., speech therapy, n = 11), and (4) waiting list (n = 14). Pre- and post-training comparisons show that only phonemic awareness has a significantly higher improvement in the AVG group compared to the waiting list, the non-AVG, and the treatment-as-usual groups, as well as the combined active groups (n = 22). This cross-modal plastic change: (i) leads to a recovery in phonemic awareness when compared to the not-at-risk pre-readers; (ii) is present in more than 80% of AVG at-risk pre-readers, and; (iii) is maintained at a 6-months follow-up. The present findings indicate that this specific multisensory attentional training positively affects how phonemic awareness develops in pre-readers at risk for developmental dyslexia, paving the way for innovative prevention programs.

Integrated focal psychotherapy: Results from a retrospective study.

Background: The focus-based integrated model (FBIM) is a form of psychotherapy that integrates psychodynamic and cognitive psychotherapy and Erikson's life cycle model. Although there are many studies on the effectiveness of integrated models of psychotherapy, few have examined the efficacy of FBIM. Objective: This pilot study explores clinical outcome measures concerning individual wellbeing, the presence/absence of symptoms, life functioning, and risk in a cohort of subjects after they received FBIM therapy. Methods: A total of 71 participants were enrolled at the CRF Zapparoli Center in Milan, 66.2% of whom were women (N = 47). The mean age of the total sample was 35.2 years (SD = 12.8). We used the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) to test treatment efficacy. Results: The results revealed that participants improved in all four dimensions of CORE-OM (i.e., wellbeing, symptoms, life functioning, and risk), women improved more than men, and in most cases (64%), the change was clinically reliable. Conclusion: The FBIM model seems to be effective for treating several patients. Most of the participants saw significant changes in symptoms, life functioning, and general wellbeing.

The Role of Phonological Working Memory and Environmental Factors in Lexical Development in Italian-Speaking Late Talkers: A One-Year Follow-Up Study.

Purpose: This follow-up study assessed (a) the influence of phonological working memory (pWM), home literacy environment, and a family history of linguistic impairments in late talkers (LTs); (b) the diagnostic accuracy of a task of nonword repetition (NWR) in identifying LTs; and (c) the persistence of lexical weaknesses after 10 months. Method: Two hundred ninety-three children were assessed at approximately 32 (t1) and 41 (t2) months. At t1, they were administered the Italian adaptation of the Language Development Survey, an NWR task (used to assess pWM), and questionnaires assessing home literacy environment and family history of language impairments. Thirty-three LTs were identified. The linguistic skills of the participants were evaluated at t2 by administering tasks assessing Articulation, Naming, Semantic Fluency, and Lexical Comprehension. Results: At t2, LTs performed more poorly as compared with age-matched typically developing peers in articulatory and naming skills, had reduced lexical comprehension abilities, and had limited lexical knowledge. Their performance on the NWR task at t1 correlated with the extension of their vocabularies at t2 (as estimated with a Semantic Fluency task). Conclusions: The Language Development Survey recently adapted to Italian is sensitive to LTs. Former LTs still have a mild lexical delay at approximately 40 months. As an indirect measure of pWM, the task of NWR is an early indicator of future lexical deficits.

The DCDC2 intron 2 deletion impairs illusory motion perception unveiling the selective role of magnocellular-dorsal stream in reading (dis)ability.

Developmental dyslexia (DD) is a heritable neurodevelopmental reading disorder that could arise from auditory, visual, and cross-modal integration deficits. A deletion in intron 2 of the DCDC2 gene (hereafter DCDC2d) increases the risk for DD and related phenotypes. In this study, first we report that illusory visual motion perception-specifically processed by the magnocellular-dorsal (M-D) stream-is impaired in children with DD compared with age-matched and reading-level controls. Second, we test for the specificity of the DCDC2d effects on the M-D stream. Children with DD and DCDC2d need significantly more contrast to process illusory motion relative to their counterpart without DCDC2d and to age-matched and reading-level controls. Irrespective of the genetic variant, children with DD perform normally in the parvocellular-ventral task. Finally, we find that DCDC2d is associated with the illusory motion perception also in adult normal readers, showing that the M-D deficit is a potential neurobiological risk factor of DD rather than a simple effect of reading disorder. Our findings demonstrate, for the first time, that a specific neurocognitive dysfunction tapping the M-D stream is linked with a well-defined genetic susceptibility.

Spatial and temporal attention in developmental dyslexia.

Although the dominant view posits that developmental dyslexia (DD) arises from a deficit in phonological processing, emerging evidence suggest that DD could result from a more basic cross-modal letter-to-speech sound integration deficit. Letters have to be precisely selected from irrelevant and cluttering letters by rapid orienting of visual attention before the correct letter-to-speech sound integration applies. In the present study the time-course of spatial attention was investigated measuring target detection reaction times (RTs) in a cuing paradigm, while temporal attention was investigated by assessing impaired identification of the first of two sequentially presented masked visual objects. Spatial and temporal attention were slower in dyslexic children with a deficit in pseudoword reading (N = 14) compared to chronological age (N = 43) and to dyslexics without a deficit in pseudoword reading (N = 18), suggesting a direct link between visual attention efficiency and phonological decoding skills. Individual differences in these visual attention mechanisms were specifically related to pseudoword reading accuracy in dyslexics. The role of spatial and temporal attention in the graphemic parsing process might be related to a basic oscillatory "temporal sampling" dysfunction.

Deeper attentional masking by lateral objects in children with autism.

Autism spectrum disorder (ASD) is often associated with a detail-oriented perception and overselective attention in visual tasks, such as visual search and crowding. These results were obtained manipulating exclusively the spatial properties of the stimuli: few is known about the spatio-temporal dynamics of visual processing in ASD. In this study we employed an attentional masking (AM) paradigm comparing children with ASD and IQ-matched typically developing (TD) controls. The AM effect refers to an impaired identification of a target followed by a competitive masking object at different proximities in space and time. We found that ASD and TD groups did not differ in the AM effect provoked by the competitive object displayed in the same position of the target. In contrast, children with ASD showed a deeper and prolonged interference than the TD group when the masking object was displayed in the lateral position. These psychophysical results suggest that the inefficient attentional selection in ASD depends on the spatio-temporal interaction between competitive visual objects. These evidence are discussed in the light of the ASD altered neural connectivity hypothesis and the reentrant theory of perception.

Action video games make dyslexic children read better.

Learning to read is extremely difficult for about 10% of children; they are affected by a neurodevelopmental disorder called dyslexia [1, 2]. The neurocognitive causes of dyslexia are still hotly debated [3-12]. Dyslexia remediation is far from being fully achieved [13], and the current treatments demand high levels of resources [1]. Here, we demonstrate that only 12 hr of playing action video games-not involving any direct phonological or orthographic training-drastically improve the reading abilities of children with dyslexia. We tested reading, phonological, and attentional skills in two matched groups of children with dyslexia before and after they played action or nonaction video games for nine sessions of 80 min per day. We found that only playing action video games improved children's reading speed, without any cost in accuracy, more so than 1 year of spontaneous reading development and more than or equal to highly demanding traditional reading treatments. Attentional skills also improved during action video game training. It has been demonstrated that action video games efficiently improve attention abilities [14, 15]; our results showed that this attention improvement can directly translate into better reading abilities, providing a new, fast, fun remediation of dyslexia that has theoretical relevance in unveiling the causal role of attention in reading acquisition.

Zoom-out attentional impairment in children with autism spectrum disorder.

Autism spectrum disorder (ASD) has long been associated with an inability to experience wholes without full attention to the constituent parts. A zoom-out attentional dysfunction might be partially responsible for this perceptual integration deficit in ASD. In the present study, the efficiency of attentional focusing mechanisms was investigated in children affected by ASD. We measured response latencies to a visual target onset displayed at three eccentricities from the fixation. Attentional resources were focused (zoom-in) or distributed (zoom-out) in the visual field presenting a small (containing only the nearest target eccentricity) or large (containing also the farthest target eccentricity) cue, 100 or 800 msec, before the target onset. Typically developing children, at the short cue-target interval, showed a gradient effect (i.e., latencies are slower at the farthest eccentricity) in the small focusing cue, but not in the large focusing cue condition. These results indicate an efficient zoom-in and zoom-out attentional mechanism. In contrast, children with ASD showed a gradient effect also in the large focusing cue condition, suggesting a specific zoom-out attentional impairment. In addition, the ASD group showed an atypical gradient effect at the long cue-target interval only in the small cue condition, suggesting a prolonged zoom-in and sluggish zoom-out attentional mechanism. This abnormal attentional focusing - probably linked to a dysfunctional top-down feedback from fronto-parietal network to the early visual areas - could contribute to the atypical visual perception associated to individuals with ASD which, in turn, could have consequences in their social-communicative development.

Visual attentional engagement deficits in children with specific language impairment and their role in real-time language processing.

In order to become a proficient user of language, infants must detect temporal cues embedded within the noisy acoustic spectra of ongoing speech by efficient attentional engagement. According to the neuro-constructivist approach, a multi-sensory dysfunction of attentional engagement - hampering the temporal sampling of stimuli - might be responsible for language deficits typically shown in children with Specific Language Impairment (SLI). In the present study, the efficiency of visual attentional engagement was investigated in 22 children with SLI and 22 typically developing (TD) children by measuring attentional masking (AM). AM refers to impaired identification of the first of two sequentially presented masked objects (O1 and O2) in which the O1-O2 interval was manipulated. Lexical and grammatical comprehension abilities were also tested in both groups. Children with SLI showed a sluggish engagement of temporal attention, and individual differences in AM accounted for a significant percentage of unique variance in grammatical performance. Our results suggest that an attentional engagement deficit - probably linked to a dysfunction of the right fronto-parietal attentional network - might be a contributing factor in these children's language impairments.

Decreased coherent motion discrimination in autism spectrum disorder: the role of attentional zoom-out deficit.

Autism spectrum disorder (ASD) has been associated with decreased coherent dot motion (CDM) performance, a task that measures magnocellular sensitivity as well as fronto-parietal attentional integration processing. In order to clarify the role of spatial attention in CDM tasks, we measured the perception of coherently moving dots displayed in the central or peripheral visual field in ASD and typically developing children. A dorsal-stream deficit in children with ASD should predict a generally poorer performance in both conditions. In our study, however, we show that in children with ASD, CDM perception was selectively impaired in the central condition. In addition, in the ASD group, CDM efficiency was correlated to the ability to zoom out the attentional focus. Importantly, autism symptoms severity was related to both the CDM and attentional zooming-out impairment. These findings suggest that a dysfunction in the attentional network might help to explain decreased CDM discrimination as well as the "core" social cognition deficits of ASD.

A causal link between visual spatial attention and reading acquisition.

Reading is a unique, cognitive human skill crucial to life in modern societies, but, for about 10% of the children, learning to read is extremely difficult. They are affected by a neurodevelopmental disorder called dyslexia. Although impaired auditory and speech sound processing is widely assumed to characterize dyslexic individuals, emerging evidence suggests that dyslexia could arise from a more basic cross-modal letter-to-speech sound integration deficit. Letters have to be precisely selected from irrelevant and cluttering letters by rapid orienting of visual attention before the correct letter-to-speech sound integration applies. Here we ask whether prereading visual parietal-attention functioning may explain future reading emergence and development. The present 3 year longitudinal study shows that prereading attentional orienting--assessed by serial search performance and spatial cueing facilitation--captures future reading acquisition skills in grades 1 and 2 after controlling for age, nonverbal IQ, speech-sound processing, and nonalphabetic cross-modal mapping. Our findings provide the first evidence that visual spatial attention in preschoolers specifically predicts future reading acquisition, suggesting new approaches for early identification and efficient prevention of dyslexia.

Attentional engagement deficits in dyslexic children.

Reading acquisition requires, in addition to appropriate phonological abilities, accurate and rapid selection of sublexical orthographic units by attentional letter string parsing. Spatio-temporal distribution of attentional engagement onto 3-pseudoletter strings was studied in 28 dyslexic and 55 normally reading children by measuring attentional masking (AM). AM refers to an impaired identification of the first of two sequentially presented masked objects (O1 and O2). In the present study, O1 was always centrally displayed, whereas the location of O2 (central or lateral) and the O1-O2 interval were manipulated. Dyslexic children showed a larger AM at the shortest O1-O2 interval and a sluggish AM recovery at the longest O1-O2 interval, as well as an abnormal lateral AM. More importantly, these spatio-temporal deficits of attentional engagement were selectively present in dyslexics with poor phonological decoding skills. Our results suggest that an inefficient spatio-temporal distribution of attentional engagement - probably linked to a parietal lobule dysfunction - might selectively impair the letter string parsing mechanism during phonological decoding.

Visual spatial attention and speech segmentation are both impaired in preschoolers at familial risk for developmental dyslexia.

Phonological skills are foundational of reading acquisition and impaired phonological processing is widely assumed to characterize dyslexic individuals. However, reading by phonological decoding also requires rapid selection of sublexical orthographic units through serial attentional orienting, and recent studies have shown that visual spatial attention is impaired in dyslexic children. Our study investigated these different neurocognitive dysfunctions, before reading acquisition, in a sample of preschoolers including children with (N=20) and without (N=67) familial risk for developmental dyslexia. Children were tested on phonological skills, rapid automatized naming, and visual spatial attention. At-risk children presented deficits in both visual spatial attention and syllabic segmentation at the group level. Moreover, the combination of visual spatial attention and syllabic segmentation scores was more reliable than either single measure for the identification of at-risk children. These findings suggest that both visuo-attentional and perisylvian-auditory dysfunctions might adversely affect reading acquisition, and may offer a new approach for early identification and remediation of developmental dyslexia.

Multisensory spatial attention deficits are predictive of phonological decoding skills in developmental dyslexia.

Although the dominant approach posits that developmental dyslexia arises from deficits in systems that are exclusively linguistic in nature (i.e., phonological deficit theory), dyslexics show a variety of lower level deficits in sensory and attentional processing. Although their link to the reading disorder remains contentious, recent empirical and computational studies suggest that spatial attention plays an important role in phonological decoding. The present behavioral study investigated exogenous spatial attention in dyslexic children and matched controls by measuring RTs to visual and auditory stimuli in cued-detection tasks. Dyslexics with poor nonword decoding accuracy showed a slower time course of visual and auditory (multisensory) spatial attention compared with both chronological age and reading level controls as well as compared with dyslexics with slow but accurate nonword decoding. Individual differences in the time course of multisensory spatial attention accounted for 31% of unique variance in the nonword reading performance of the entire dyslexic sample after controlling for age, IQ, and phonological skills. The present study suggests that multisensory "sluggish attention shifting"-related to a temporoparietal dysfunction-selectively impairs the sublexical mechanisms that are critical for reading development. These findings may offer a new approach for early identification and remediation of developmental dyslexia.

Sluggish engagement and disengagement of non-spatial attention in dyslexic children.

Although the dominant view posits that developmental dyslexia arises from a deficit in phonological processing and memory, efficient phonological decoding requires precise visual selection of graphemes. Therefore, visual engagement and disengagement of non-spatial attention were studied in 13 dyslexic children and 13 chronological age and intelligence quotient (IQ) matched normally reading children by measuring "attentional masking" (AM) and "attentional blink" (AB) effects. AM refers to an impaired identification of the first (T1) of two rapidly sequential targets (i.e., attentional engagement). In contrast, AB refers to an impaired identification of the second target in the sequence (T2; i.e., attentional disengagement). The results revealed a specific temporal deficit of AM as well as of AB in dyslexic children. Our results showed that the abnormality in AM and AB is rather widespread, since 77% and 54% of dyslexic children deviated at least 1 standard deviation (SD) from the mean of the controls, respectively, for the two deficits. We further showed that individual differences in non-spatial attention were specifically related to nonword reading ability. These results suggest that non-spatial attention deficits (possibly related to a parietal cortex dysfunction) may selectively impair the reading development via sub-lexical mechanisms.

Neuropsychological deficits and neural dysfunction in familial dyslexia.

We report the neuropsychological profile and the pattern of brain activity during reading tasks in a sample of familial dyslexics. We studied our subjects with an in-depth neuropsychological assessment and with functional neuroimaging (fMRI) during word and pseudoword reading and false font string observations (baseline condition). The neuropsychological assessment revealed that familial dyslexia, in both persistent and compensated forms, is often associated with deficits in verbal short-term memory, phonological awareness and automatization abilities. The functional results showed a lack of activation in the posterior areas of the reading network. This study, together with the previously published VBM study (Brambati, S.M., Termine, C., Ruffino, M., Stella, G., Fazio, F., Cappa, S.F. and Perani, D., Regional reductions of gray matter volume in familial dyslexia, Neurology, 63 (2004) 742-5), provides a multiple modality evaluation of familial dyslexia. The neuropsychological assessment showed cognitive deficits associated with dyslexia that persist also in subjects with compensated reading deficit. Both the anatomical and the functional study point out a deficit in the posterior areas of the reading network.