The challenge of remote treatment in neuropsychological intervention for reading and spelling in dyslexia: A prospective observational cohort study.

Telemedicine approaches have proved to be valuable solutions for the delivery of treatment for many health-related issues, and crucial during the pandemics. Nonetheless, the efficacy of such Web-based practices in developmental dyslexia needs to be thoroughly evaluated. To this aim, the effects of a multi-componential program for neuropsychological intervention in dyslexia delivered as an outpatient program were compared with those obtained with a remotely delivered, Web-based treatment, based on the same methodological principles and delivered with the same duration and intensity. The treatment-related changes obtained with a combination of visual hemisphere-specific stimulation and training of visual-spatial attention through action video games, were compared to those obtained through remote treatment via the Tachidino Web-based platform. Both treatments had a duration of 4 weeks. The same battery of reading and phonemic awareness tests was delivered in presence, before and after treatment, as well as at 6-months follow-up. User satisfaction was assessed through parents and user questionnaires. Both treatments were significantly and similarly effective in improving reading speed, reading accuracy, and writing accuracy. No reduction in the effects was observed after treatment discontinuation. The Web-based treatment may thus offer a valid alternative to in-person intervention, optimizing the flexibility, capillary diffusion and cost-effectiveness of intervention.

Intergenerational longitudinal associations between parental reading/musical traits, infants' auditory processing, and later phonological awareness skills.

The intergenerational transmission of language/reading skills has been demonstrated by evidence reporting that parental literacy abilities contribute to the prediction of their offspring's language and reading skills. According to the "Intergenerational Multiple Deficit Model," literacy abilities of both parents are viewed as indicators of offspring's liability for literacy difficulties, since parents provide offspring with genetic and environmental endowment. Recently, studies focusing on the heritability of musical traits reached similar conclusions. The "Musical Abilities, Pleiotropy, Language, and Environment (MAPLE)" framework proposed that language/reading and musical traits share a common genetic architecture, and such shared components have an influence on the heritable neural underpinnings of basic-level skills underlying musical and language traits. Here, we investigate the intergenerational transmission of parental musical and language-related (reading) abilities on their offspring's neural response to a basic auditory stimulation (neural intermediate phenotype) and later phonological awareness skills, including in this complex association pattern the mediating effect of home environment. One-hundred and seventy-six families were involved in this study. Through self-report questionnaires we assessed parental reading abilities and musicality, as well as home literacy and musical environment. Offspring were involved in a longitudinal study: auditory processing was measured at 6 months of age by means of a Rapid Auditory Processing electrophysiological paradigm, and phonological awareness was assessed behaviorally at 5 years of age. Results reveal significant correlations between parents' reading skills and musical traits. Intergenerational associations were investigated through mediation analyses using structural equation modeling. For reading traits, the results revealed that paternal reading was indirectly associated with children's phonological awareness skills via their electrophysiological MisMatch Response at 6 months, while maternal reading was directly associated with children's phonological awareness. For musical traits, we found again that paternal musicality, rather than maternal characteristics, was associated with children's phonological phenotypes: in this case, the association was mediated by musical environment. These results provide some insight about the intergenerational pathways linking parental reading and musical traits, neural underpinnings of infants' auditory processing and later phonological awareness skills. Besides shedding light on possible intergenerational transmission mechanisms, this study may open up new perspectives for early intervention based on environmental enrichment.

Evaluating the role of word-related parameters in the discriminative power of a novel nonword repetition task for bilingual children.

In bi- and monolingual children, nonword repetition tasks (NWRTs) differentiate typically developing (TD) children from children with Developmental Language Disorder (DLD) or children with a risk of DLD. Previous research has highlighted the importance of considering language specificity in nonword (NW) construction especially for bilingual children. A novel NWRT has been designed for the screening of DLD risk in the bilingual Italian-German preschool population, creating lists of language-specific (for the two target languages) and language-non-specific NWs. This study aimed to test the discriminative validity of this NWRT and to identify the characteristics of the NWs that maximise discriminative validity within language-specific and language-non-specific subsets. The findings confirm the role of language specificity (in terms of target language alikeness) but also of other characteristics related to word structure complexity.

Long-Lasting Effects of Changes in Daily Routine during the Pandemic-Related Lockdown on Preschoolers' Language and Emotional-Behavioral Development: A Moderation Analysis.

The quantity and quality of environmental stimuli and contexts are crucial for children's development. Following the outbreak of SARS-CoV-2 (COVID-19), restrictive measures have been implemented, constraining children's social lives and changing their daily routines. To date, there is a lack of research assessing the long-lasting impacts that these changes have had on children's language and emotional-behavioral development. In a large sample of preschoolers (N = 677), we investigated (a) the long-lasting effects of changes in family and social life and in daily activities over the first Italian nationwide COVID-19-pandemic-related lockdown upon children's linguistic and emotional-behavioral profiles and (b) how children's demographic variables and lifelong family characteristics moderated these associations within a multiple-moderator framework. Our findings showed a relationship between the time spent watching TV/playing video games and affective problems that was moderated by the number of siblings. Our findings showed that children who could be at high risk in more normal circumstances, such as only children, have been particularly harmed. Therefore, assessing the long-term effects of lockdown-related measures and how these could have been moderated by potential risk/protective factors added significant information to the existing literature.

Associations between Dietary Intake, Blood Levels of Omega-3 and Omega-6 Fatty Acids and Reading Abilities in Children.

Lower levels of omega-3 polyunsaturated fatty acids (PUFAs) have been described in individuals with reading difficulties, but the degree and the nature of such deficiencies as well as the role of nutrition are a matter of debate. The aim of the present study was to investigate the associations between PUFA blood levels, nutritional status, and reading/writing/phonological awareness performances in 42 school-age children with varying levels of reading ability. Significant correlations were found between PUFA levels (specific omega-6/omega-3 ratios), the ratio of omega-6-derived calories to the total amount of calories and reading scores. Mediation analysis showed a mediating effect of fatty acids on the association between reading speed scores and nutritional status. Moderation analysis, moreover, showed that the associations of omega-6/omega-3 ratios in the blood and Kcal omega-6/Kcal total in dietary intake were moderated by reading speed performances. Results of the mediation and moderation models confirm that the associations of dietary intake with PUFA levels in the blood vary depending on learning abilities. Reading skills appear to be sensitive to the effects of a complex set of favorable conditions related to the presence of higher omega-3 blood levels. These conditions may reflect the action of dietary as well as genetic and epigenetic mechanisms.

Revisiting Multifactor Models of Dyslexia: Do They Fit Empirical Data and What Are Their Implications for Intervention?

Developmental dyslexia can be viewed as the result of the effects of single deficits or multiple deficits. This study presents a test of the applicability of a multifactor-interactive model (MFi-M) with a preliminary set of five variables corresponding to different neuropsychological functions involved in the reading process. The model has been tested on a sample of 55 school-age children with developmental dyslexia. The results show that the data fit a model in which each variable contributes to the reading ability in a non-additive but rather interactive way. These findings constitute a preliminary validation of the plausibility of the MFi-M, and encourage further research to add relevant factors and specify their relative weights. It is further discussed how subtype-based intervention approaches can be a suitable and advantageous framework for clinical intervention in a MFi-M perspective.

Remote treatment of developmental dyslexia: how ADHD comorbidity, clinical history and treatment repetition may affect its efficacy.

Introduction: Tachidino is a web-based platform for remote treatment of reading and spelling disorders. The purpose of the present study was to investigate the possible impact of different clinical conditions on the efficacy of treatment. The focus was on possible ADHD comorbidity-related effects on the outcomes of the Tachidino treatment, and the impact of previous treatments, such as speech and language therapy or the repetition of the same Tachidino program. Methods: 136 children with developmental dyslexia received four-weeks treatment via the Tachidino platform. Improvements in reading and writing scores were compared between different subgroups. Results: No gross differences emerged in treatment effectiveness between groups of children. Children receiving treatment improved significantly more than untreated children. Discussion: Treatment with Tachidino brought significant benefits for all children, irrespective of comorbidity, clinical history or treatment repetition. Comparison with an untreated control group (waiting list) made it possible to exclude that improvement was due to test-retest learning effects.

A Nonword Repetition Task Discriminates Typically Developing Italian-German Bilingual Children From Bilingual Children With Developmental Language Disorder: The Role of Language-Specific and Language-Non-specific Nonwords.

In bi- and monolingual children, nonword repetition tasks (NWRTs) differentiate between typically developing (TD) and children with Developmental Language Disorder (DLD). Language specificity is a crucial factor in nonword construction especially for multilingual children. While language-specific nonwords seem less artificial than non-specific nonwords, the application of language-specific phonemes may be less suitable for bilingual children who are exposed to the target language less than monolingual peers. This study evaluates the concurrent and predictive value of a novel, computerized NWRT implemented in the MuLiMi web-platform and its potential in the discrimination of bilingual children with and without DLD, investigating the role of nonwords' language specificity. Thirty-seven children (of whom 17 had an objective risk of phonological disorders) with at least one Italian-speaking parent, living and attending kindergartens in Germany were tested with the MuLiMi NWRT and German standardized language tests. Caregivers and kindergarten teachers filled in questionnaires. Fourteen of the children were re-tested after 8-12 months. The results suggest that the new test's concurrent and discriminative validity are good. Analysis of variance revealed highly significant differences between children with and without (an objective risk of) phonological disorders and a significant interaction between nonword specificity and risk group. Significant correlations of initial scores with follow-up scores collected after 8-12 months were also found, as well as correlations with improvements in language abilities. In conclusion, although both language-specific and language-non-specific nonword repetition can support DLD risk identification in bilingual children, language-specific stimuli appear to be particularly sensitive indicators. This is interpreted as confirming DLD children's reduced sensitivity to frequent, familiar characteristics of the linguistic stimuli. The test's discriminative and concurrent validity showed to be robust to various potentially influencing factors like patterns of language exposure.

Direct and Indirect Effects of Blood Levels of Omega-3 and Omega-6 Fatty Acids on Reading and Writing (Dis)Abilities.

The purpose of the present study was to investigate whether there are associations between polyunsaturated fatty acid (PUFA) blood levels, reading/writing performance and performance in neuropsychological tasks. Moderate to strong correlations were found between PUFA levels (specific omega-6/omega-3 ratios) and reading/writing abilities, and the former and neuropsychological test scores. Mediation models analyzing the direct and indirect effects of PUFA on reading and writing scores showed that the effects of fatty acids on learning measures appear to be direct rather than mediated by the investigated visual and auditory neuropsychological mechanisms. The only significant indirect effect was found for the difference in accuracy between the left and right visual fields in visual-spatial cueing tasks, acting as a mediator for the effect of PUFA ratios on writing accuracy. Regression analyses, by contrast, confirmed the roles of phonological awareness and other visual attentional factors as predictors of reading and writing skills. Such results confirm the crucial role of visual-spatial attention mechanisms in reading and writing, and suggest that visual low-level mechanisms may be more sensitive to the effects of favorable conditions related to the presence of higher omega-3 blood levels.

Remote Neuropsychological Intervention for Developmental Dyslexia with the Tachidino Platform: No Reduction in Effectiveness for Older Nor for More Severely Impaired Children.

Tachidino is a web-platform for remote treatment of reading and writing disorders. A total of 91 children with developmental dyslexia and/or dysorthographia participated in the present study and received Tachidino treatment. The purpose of the study was to compare results obtained after four weeks treatment and a six-month follow-up in older versus younger children and in more versus less severely impaired children (separately subdividing them according to reading speed, reading accuracy, and writing accuracy). The results showed no difference in improvement for reading accuracy and speed in the three age groups, but children below 9 years improved more than older children in writing accuracy. Regarding severity groups, children with more severe initial impairments improved more than children with less severe impairments. Additionally, the results were confirmed after controlling for spurious effects due to use of Z-scores and regression to the mean. The findings are discussed in terms of their theoretical and practical implications.

Towards Consensus on Good Practices for the Use of New Technologies for Intervention and Support in Developmental Dyslexia: A Delphi Study Conducted among Italian Specialized Professionals.

The use of new technologies for intervention in developmental dyslexia is steadily growing. In order to better understand the needs, the expectations, and the attitudes of Italian expert health professionals concerning such technologies, a national survey was conducted applying the Delphi methodology. Ad-hoc questionnaires were sent out to a group of eighteen experts over three successive rounds, and anonymously collected responses were aggregated and shared with the group after each round, aiming to reach a consensus on the proposed response. The goal was to define a series of statements that could form the basis for international "good practices" in the use of technologies for intervention to support dyslexia in children and adolescents. In the first round, the experts' general opinions were collected with both multiple choice and open questions, and in the second round consensus was assessed on a series of statements based on the first replies. The cut-off of 75% consensus on each statement was reached after three rounds. Fifteen experts completed all the rounds of the process, and a final version of the statements regarding good practice in the use of technologies for dyslexia could be defined.

Developmental Language Disorder: Early Predictors, Age for the Diagnosis, and Diagnostic Tools. A Scoping Review.

BACKGROUND: Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. METHODS: We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. RESULTS: Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. CONCLUSIONS: Monitoring risk situations and employing caregivers' reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions.

Detection without further processing or processing without automatic detection? Differential ERP responses to lexical-semantic processing in toddlers at high clinical risk for autism and language disorder.

Delays in early expressive vocabulary can reflect a specific delay in language acquisition or more general impairments in social communication. The neural mechanisms underlying the (dis)ability to establish the first lexical-semantic representations remain relatively unknown. Here, we investigate the electrophysiological underpinnings of these mechanisms during the critical phase of lexical acquisition in two groups of 19-month-old toddlers at risk for neurodevelopmental disorders, i.e., children characterized by low expressive vocabulary (late talkers, N = 18) and children with early signs of Autism Spectrum Disorder (ASD, N = 18) as compared to typically developing children (N = 28), with the aim to identify similarities and specificities in lexical-semantic processing between these groups. ERPs elicited by words (either congruous or incongruous with the previous picture context) and pseudo-words are investigated within a picture-word matching paradigm. In order to further interpret ERP responses, we look at longitudinal intra-group associations with language and socio-communications skills at age 24 months. As expected, we found differences between the groups that might underlie specificities, but also similarities. On the one side, late talkers differed from the other two groups in the early component (phonological-lexical priming effect) reflecting detection of the correspondence between the heard word and the lexical representation pre-activated by the picture. On the other side, children with early symptoms of ASD differed from the other two groups in the late component (late positive component) reflecting the effortful semantic re-analysis following a violation. The functional interpretation of the two components is corroborated by significant correlations suggesting that the early component is associated with later socio-communication skills, whereas the late component is associated with linguistic skills. Results point in the direction of differential impaired mechanisms in the two populations, i.e., impaired automatic detection of incongruencies in late talkers vs. absence of high-level re-analysis of such incongruencies in children with early signs of ASD.

The processing of rhythmic structures in music and prosody by children with developmental dyslexia and developmental language disorder.

Rhythm perception seems to be crucial to language development. Many studies have shown that children with developmental dyslexia and developmental language disorder have difficulties in processing rhythmic structures. In this study, we investigated the relationships between prosody and musical processing in Italian children with typical and atypical development. The tasks aimed to reproduce linguistic prosodic structures through musical sequences, offering a direct comparison between the two domains without violating the specificities of each one. About 16 Typically Developing children, 16 children with a diagnosis of Developmental Dyslexia, and 16 with a diagnosis of developmental language disorder (age 10-13 years) participated in the experimental study. Three tasks were administered: an association task between a sentence and its humming version, a stress discrimination task (between couples of sounds reproducing the intonation of Italian trisyllabic words), and an association task between trisyllabic nonwords with different stress position and three-notes musical sequences with different musical stress. Children with developmental language disorder perform significantly lower than Typically Developing children on the humming test. By contrast, children with developmental dyslexia are significantly slower than TD in associating nonwords with musical sequences. Accuracy and speed in the experimental tests correlate with metaphonological, language, and word reading scores. Theoretical and clinical implications are discussed within a multidimensional model of neurodevelopmental disorders including prosodic and rhythmic skills at word and sentence level.

The Effectiveness of Interventions for Developmental Dyslexia: Rhythmic Reading Training Compared With Hemisphere-Specific Stimulation and Action Video Games.

Developmental dyslexia is a very common learning disorder causing an impairment in reading ability. Although the core deficit underlying dyslexia is still under debate, significant agreement is reached in the literature that dyslexia is related to a specific deficit in the phonological representation of speech sounds. Many studies also reported an association between reading skills and music. These findings suggest that interventions aimed at enhancing basic auditory skills of children with DD may impact reading abilities. However, music education alone failed to produce improvements in reading skills comparable to those resulting from traditional intervention methods for DD. Therefore, a computer-assisted intervention method, called Rhythmic Reading Training (RRT), which combines sublexical reading exercises with rhythm processing, was implemented. The purpose of the present study was to compare the effectiveness of RRT and that of an intervention resulting from the combination of two yet validated treatments for dyslexia, namely, Bakker's Visual Hemisphere-Specific Stimulation (VHSS) and the Action Video Game Training (AVG). Both interventions, administered for 13 h over 9 days, significantly improved reading speed and accuracy of a group of Italian students with dyslexia aged 8-14. However, each intervention program produced improvements that were more evident in specific reading parameters: RRT was more effective for improvement of pseudoword reading speed, whereas VHSS + AVG was more effective in increasing general reading accuracy. Such different effects were found to be associated with different cognitive mechanisms, namely, phonological awareness for RRT and rapid automatized naming for VHSS + AVG, thus explaining the specific contribution of each training approach. Clinical Trial registration: ClinicalTrials.gov NCT02791841.

Improving the "real life" management of schizophrenia spectrum disorders by LAI antipsychotics: A one-year mirror-image retrospective study in community mental health services.

Schizophrenia poses a significant economic burden on the healthcare system as well as it has a significant impact on society at large. Reasons for such a high economic burden of schizophrenia include the frequent relapses and hospitalizations occurring in this disorder. We analyze the effectiveness of long-acting injectable antipsychotics (LAIs) compared to oral medications, in terms of "clinical process management" in a sample of patients with a diagnosis of schizophrenia spectrum disorder treated in community mental health centers. An observational, retrospective, mirror-image study was carried out to evaluate the effectiveness of LAIs compared to oral medications in terms of number of hospitalizations, emergency visits and planned visits on a 10-year period (from July 2007 to June 2017). Differences between first and second generation LAIs were also explored. Our findings show that hospitalization and emergency visits are significantly decreased with the use of LAIs, while planned visits are increased in patients treated with LAIs. Our results suggest that LAIs, in particular, second generation ones, reduce hospitalization rates and emergency visits, improving the economic burden of schizophrenia. Therefore, LAIs should be considered a cost-effective treatment in the management of schizophrenia under routine conditions.

Tell Me a Story: Socio-Emotional Functioning, Well-Being and Problematic Smartphone Use in Adolescents With Specific Learning Disabilities.

Although Specific Learning Disabilities (SLD) are described as specific difficulties in one or more academic areas, often socio-emotional problems are also reported to be related to well-being and school engagement. Moreover, recent evidence shows that emotional problems and reduced social support predict problematic use of new technologies, such as a smartphone, that can, in turn, increase these problems. In this study, we aimed to investigate socio-emotional functioning and its relation to well-being, school engagement, and problematic smartphone use. Social and emotional skills of 19 adolescents with a diagnosis of SLD and 19 control adolescents were assessed through a narrative test; adolescents were requested to narrate complete stories elicited by pictures representing social situations. Information on well-being and problematic smartphone use were collected through questionnaires. The comparison between groups showed differences in cognitive-social skills, although no significant differences in emotional functioning were found. Additionally, the perception of the social environment as supportive and trustworthy was related to general well-being for both groups, whereas the perception of limits and rules set by the adult world appeared to be related to a decreased investment in learning processes only for the SLD students. Finally, correlation analysis showed that smartphone use was associated with reduced perception of social support and to a decreased ability to understand and solve social situations. These results assert the critical role played by social information processing and social support in terms of well-being in adolescence, and contribute to enhancing knowledge of the mechanisms underlying problematic smartphone use in a clinical sample.

Developmental Differences in the Relationship Between Visual Attention Span and Chinese Reading Fluency.

It has been suggested that there is a close relationship between visual attention span (VAS) and fluent reading. This relation may be modulated by participants' age, and exhibits various patterns in different reading modes (i.e., oral vs. silent reading) and different reading levels (e.g., sentence vs. character/word levels). Moreover, the modulation effects from the above factors might be more remarkable in the framework of languages with a deep orthography. Therefore, the present study investigated the developmental pattern of the relationship between VAS skills and reading fluency in Chinese, a language with particularly deep orthography, by recruiting 292 participants from primary schools, middle schools, and universities. Two tests were utilized to assess fluent reading skills at the single-character and sentence levels with oral and silent reading modes. A visual 1-back task was adopted to reflect VAS capacity with non-verbal stimuli and no verbal response. Results showed that the VAS capacity of low-grade primary school students could significantly account for the variance in single-character reading fluency in the oral mode and that it was a significant predictor of sentence reading fluency in the oral mode among high-grade primary school students. VAS abilities of middle school students allowed a unique and stable prediction of their silent sentence reading. With increasing reading ability, VAS skills of adults showed significant and similar predictive power for estimating the variations in fluent sentence reading in both silent and oral modes. These results revealed developmental changes in the contribution of VAS to fluent reading in Chinese, and provided evidence unveiling whether the underlying mechanisms of oral and silent reading were shared or different.

ORCA.IT: A New Web-Based Tool for Assessing Online Reading, Search and Comprehension Abilities in Students Reveals Effects of Gender, School Type and Reading Ability.

ORCA.IT, a new online test of online research and comprehension was developed for the Italian population. A group of 183 students attending various types of upper secondary schools in Northern Italy were tested with the new tool and underwent further cognitive and neuropsychological assessment. The different school types involved in the study are representative of the school population in the Italian system, but can also be easily compared with the educational systems of other countries. The new test turned out to have good psychometric properties after accurate item construction and final selection. In particular, Version 1 showed better characteristics than Version 2. Subsequently, comparison with one-way ANOVAs were performed to test whether differences exist between different school types, between groups with and without reading difficulties, and between males and females. Such differences are sometimes reported in the literature, but many remain controversial. Further, Pearson's bivariate correlations were calculated to analyze associations between scores on the ORCA.IT and cognitive/neuropsychological variables. Finally, a stepwise regression analysis was performed on aggregated scores to identify the predictors of performance on each of the two versions. The test, especially in the most complete version (Version 1), appears to accurately and reliably capture students' web searching abilities and online reading comprehension. The tool could highlight differences in online search and comprehension ability between students with and without reading difficulties, not penalizing overall performance but allowing very specific weaknesses to be pointed out. Further, it seems to be able to capture differences due to both educational pathways (different school types) and social attitudes (differences between males and females). Most interestingly, it shows to be clearly resting on specific cognitive and neuropsychological abilities, including language, memory, and attentional skills, which explain a large portion of the total variance. Offline text reading comprehension is a crucial predictor of online reading performance, while decoding ability is not. Prior knowledge also influences the results, as expected. The new tool turns out to be rather independent of previous Internet experience and to measure more cognitively grounded processes related to information gathering, processing, and communicating.