Toward the characterization of a visual form of developmental dyslexia: Reduced visuo-attentional capacity for processing multiple stimuli made of separable features.

Some dyslexics cannot process multiple letters simultaneously. It has been argued that this reduced visuo-attentional (VA) letter span could result from poor reading ability and experience. Here, moving away from reading context, we showed that dyslexic group exhibited slower visual search than normal readers group for "symbols", defined as graphic stimuli made up of separable visual features, but not for filled objects. Slowness in symbol visual search was explained by reduced VA field and atypical ocular behaviour when processing those letter-like stimuli and was associated with reduced VA letter span and impaired elementary visuo-spatial perception. Such a basic visual search deficit can hardly be attributed to poor reading ability and experience. Moreover, because it is specific to letter-like stimuli (i.e., "symbols"), it can specifically hinder reading acquisition. Symbol visual search can easily be tested in the pre-reading phase, opening up prospects for early risk detection and prevention of VA dyslexia.

Enhancing reading accuracy through visual search training using symbols.

Children with reading disorders present with inaccurate and/or delayed printed word identification. Regarding visual-attentional processing, printed words are letter strings, and each letter is a symbol made of separable features. Simultaneous processing of separable features has been evidenced to be specifically impaired in visual search tasks using symbols in poor readers as well as in a patient with superior parietal lobules (SPL) lesion. Additionally, activation in the SPL has been shown to be abnormally low in dyslexic readers displaying a reduced span of letter strings processing. This deficit has been assumed to impair visual-attentional sampling of printed words. An experiment conducted with 21 dyslexic children tested the hypothesis that a training program based on visual symbol search may stimulate the SPL, leading to a potential benefit transferred to reading performance. We designed the VisioCogLetters serious game and introduced it at random for one month (10 min every day) between four monthly reading sessions. No training was provided between the other (control) reading sessions. Reading accuracy increased without any speed-accuracy trade-off specifically in the session after training. Moreover, the percentage of improvement correlated with the individual time spent at home on training. These results show that improved visual search skills on symbols can translate into enhanced reading performance, and pave a new avenue for future rehabilitation tools.

Attentional limits in visual search with and without dorsal parietal dysfunction: space-based window or object-based span?

Attentional resource and distribution are specifically impaired in simultanagnosia, and also in the visuo-attentional form of developmental dyslexia. Both clinical conditions are conceived as a limitation of simultaneous visual processing after superior parietal lobule (SPL) dysfunction (review in Valdois et al., 2019). However, a reduced space-based attentional window (i.e. a limited visual eccentricity at which the target object can be identified, Khan et al. 2016) has been demonstrated in simultanagnosia versus a reduced object-based span (i.e. a limited number of objects processed at each fixation, Bosse et al., 2007) in developmental dyslexia. In healthy individuals, the cost in reaction times per item in serial search tasks suggests that a group of objects is processed simultaneously at a time, but this group is also undefined and depends on the visual complexity of the task. Healthy individuals and a patient with simultanagnosia performed serial search tasks involving either symbols (made of separable features) or objects made of non-separable features, and with distractors that were either all identical or all dissimilar. We used a moving window paradigm to determine whether the task was performed with a "working space" versus a "working span" limitation in control group and in patient with bilateral SPL damage. We found that healthy individuals performed search in a color task comprising non-separable feature objects and dissimilar distractors with a limited space-based attentional window; this attentional window, as well as the mean saccade amplitude used to displace it across the visual display, were independent of set size, thus inconsistent with an object-based attentional span. In the symbol task comprising a feature-absent search in which all feature-present distractors were dissimilar, we observed that mean saccade amplitude decreased with set size and that search performance could not be mimicked by a moving window of a single diameter; instead participants seemed to process a fixed number of symbols at a time (object-based span). Following bilateral SPL lesions, patient IG demonstrated a similar space-based search process in the color search task with a normal attentional window. In contrast, her cost-per-item in the symbol task increased dramatically, demonstrating a clear deficit of simultaneous object perception. These results confirmed the specific contribution of the SPL to the visual processing of multiple objects made of separable features (like letters), and more dramatically when they are all different, which explains the specific difficulty for a reading beginner in case of SPL dysfunction.

Bálint syndrome.

This chapter starts by reviewing the various interpretations of Bálint syndrome over time. We then develop a novel integrative view in which we propose that the various symptoms, historically reported and labeled by various authors, result from a core mislocalization deficit. This idea is in accordance with our previous proposal that the core deficit of Bálint syndrome is attentional (Pisella et al., 2009, 2013, 2017) since covert attention improves spatial resolution in visual periphery (Yeshurun and Carrasco, 1998); a deficit of covert attention would thus increase spatial uncertainty and thereby impair both visual object identification and visuomotor accuracy. In peripheral vision, we perceive the intrinsic characteristics of the perceptual elements surrounding us, but not their precise localization (Rosenholtz et al., 2012a,b), such that without covert attention we cannot organize them to their respective and recognizable objects; this explains why perceptual symptoms (simultanagnosia, neglect) could result from visual mislocalization. The visuomotor symptoms (optic ataxia) can be accounted for by both visual and proprioceptive mislocalizations in an oculocentric reference frame, leading to field and hand effects, respectively. This new pathophysiological account is presented along with a model of posterior parietal cortex organization in which the superior part is devoted to covert attention, while the right inferior part is involved in visual remapping. When the right inferior parietal cortex is damaged, additional representational mislocalizations across saccades worsen the clinical picture of peripheral mislocalizations due to an impairment of covert attention.

Elementary visuospatial perception deficit in children with neurodevelopmental disorders.

AIM: To assess the prevalence of elementary visuospatial perception (EVSP) deficit in children with neurodevelopmental disorders. METHOD: Using a screening test designed and validated to measure dorsal EVSP ability, 168 children (122 males, 46 females; mean age 10y [SD 1y 10mo], range 4y 8mo-16y 4mo) diagnosed with developmental coordination disorder (DCD), specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), and/or oral language disorder were compared with a group of 184 typically developing children. We also tested 14 children with binocular vision dysfunction and no neurodevelopmental disorder. RESULTS: Children with SLD scored below the interquartile range of typically developing children as frequently (59%) as children with DCD, but only 5% were severely impaired (i.e. scored as outliers). Children with DCD were the most severely impaired (22% of outliers), even more so when they exhibited a co-occuring disorder. Children with language disorder and those with binocular vision dysfunction scored similarly to the group of typically developing children. INTERPRETATION: These results confirm the importance of assessing EVSP in the clinical evaluation of children with neurodevelopmental disorders, in particular those presenting with DCD or SLD. What this paper adds More than half of children with developmental coordination disorder (DCD) scored below the normal interquartile range on the elementary visuospatial perception (EVSP) test. More than half of children with specific learning disorder (SLD) scored below the normal interquartile range on the EVSP test. Twenty-two percent of children with DCD performed as outliers on the EVSP test. Children with language disorder and those with binocular vision dysfunction scored similarly to typically developing children.